Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting.
OBJECTIVE
Minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending artery has become a routine operation. We present our clinical experiences with beating heart MIDCAB surgery performed through partial lower sternotomy (PLS) and retrospectively compare the results of pain perception as well as activities of daily life (ADL) with the conventional full sternotomy.


METHODS
From January 2009 to August 2012, 197 patients underwent MIDCAB using modified PLS at our hospital. Their mean age was 58.5±10.5 years. 54 (28%) had previous myocardial infarction, 38 (19%) had diabetes mellitus. The visual analog scale (VAS) for pain one, two and three, the ADL score for mobilization were obtained within four days after surgery. 98% of patients were followed-up with both direct visits and questionnaires to assess the major adverse cardiac events (MACE). We performed t-test for comperative data and Kaplan-Meier curves for survival analysis.


RESULTS
There was one postoperative death (0.5%) and three conversions to full sternotomy (1.5%). Postoperative angiography was performed in 34 (17.2%) patients, who had some symptoms during the follow-up period of 45 months. The graft patency rate was 96.5% (190 of 197). At follow-up (24.1±11.7 months), survival free of MACE was 91.8±3.1% at 3.5 years. Both the Visual Analog Scale (35.1±9.6 vs. 57.1±7.8) and the ADL score (80.4±11.8 vs. 36.2±8.6) were significantly higher after the operation in comparison to the matched group of beating heart revascularizations with full sternotomy (p<0.001).


CONCLUSIONS
This study demonstrates that the MIDCAB using PLS can achieve an effective intermediate-term revascularization and an acceptable clinical outcome. Patients who undergo this procedure are free of major complications and enjoy good quality of life after surgery.
Clinics of Cardiovascular Surgery and Pain Medicine, TOBB University Medical Center; Ankara-Turkey. tayfun@aybek.de.
Barış
B
Uymaz
Gül
G
Sezer
Pınar
P
Köksal Coşkun
Onurcan
O
Tarcan
Seyhan
S
Ozleme
Tayfun
T
Aybek
D000203:Activities of Daily Living; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology*; D013249:Sternum; D011795:Surveys and Questionnaires; D016896:Treatment Outcome