Ministernotomy in myocardial revascularization preserves postoperative pulmonary function.
BACKGROUND
In coronary artery bypass graft (CABG) surgery, the need to perform a midsternotomy has been considered a factor for the decrease in postoperative pulmonary function.


OBJECTIVE
To prospectively evaluate early postoperative (PO) pulmonary function in patients submitted to off-pump CABG, comparing the conventional midsternotomy with the ministernotomy approach.


METHODS
A total of 18 patients were evaluated and assigned to the two groups: Group Conventional Midsternotomy (CMS, n=10) and Group Ministernotomy (MS, n=8). Spirometric results of the forced vital capacity (FVC) and the Forced Expiratory Volume in one second (FEV1) were obtained on the 1st, 3rd and 5th PO days and the arterial gasometry was obtained before and on the 1st PO day. The pulmonary shunt percentage and the pain score were also assessed.


RESULTS
When compared in terms of percentage of the preoperative value, the FVC was higher in the MS group than in the CMS group on the 1st, 3rd and 5th PO days (p<0.001). Similar results were obtained for FEV1. The recovery of the FVC between the 1st and the 5th PO days was higher in the MS than in the CMS group (p=0,043). The PaO2 decreased on the 1st PO day in both groups (p<0.05), with a higher decrease in the CMS group (p=0.002). The shunt increased in the two groups on the 1st PO day (p<0.05); however, it was lower in the MS group (p=0.02). The reported pain score was lower and the duration of the hospital stay was shorter in the MS group.


CONCLUSIONS
Patients submitted to CABG by MS present better preservation and recovery of pulmonary function than those submitted to CMS.
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Solange
S
Guizilini
Douglas W
DW
Bolzan
Sonia M
SM
Faresin
Francisco A
FA
Alves
Walter J
WJ
Gomes
D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D056346:Sternotomy / Q000009:adverse effects* / Q000379:methods*; D014797:Vital Capacity / Q000502:physiology*