title: Comparison of early and late quality of life between left anterior thoracotomy and median sternotomy off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  Minimally invasive coronary artery bypass surgery performed through a left thoracotomy has potential benefits over conventional sternotomy, including reduced surgical trauma, faster recovery and potential improvement in quality of life. This study is a prospective assessment of quality of life in patients undergoing off-pump coronary bypass by median sternotomy and left anterior thoracotomy.
  
  
  METHODS
  Quality of life was assessed by the EuroQoL questionnaire, with additional questions on dyspnoea, angina, wound pain and scar aesthetics. Outcomes were compared across the data sets at pre-operation, three weeks and three months post-operation.
  
  
  RESULTS
  Sixty-six (17 minimally invasive and 49 off-pump) patients (mean age 65±12, 7 females and 59 males) were included. Significant differences in mean EuroQol outcomes were observed for activities, F(1,64) = 5.86, (p<0.05), pain scores, F(1,64) = 4.658 (p=0.035) and scar aesthetics, F(1,64) = 16.83 (p<0.05). There was an additional significant interaction, F(1.898, 121.49) = 3.282, (p<0.05), between time and group for activity levels; exploring this further indicated no significant difference at baseline, but significantly greater improvement observed in the minimally invasive group over time. At 3 weeks, 50% of minimally invasive patients compared to 82% of sternotomy patients (p<0.001) required oral analgesia. At 3 months, 8% of minimally invasive patients and 21% of sternotomy patients (p<0.001) required oral analgesia.
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass performed with a minimally invasive approach through a left thoracotomy appears to result in earlier improvement in quality of life outcomes compared to conventional sternotomy. These results are important when counselling patients regarding the benefits and difference between a left anterior thoractomy MIDCABG and conventional OPCAB and can be used as pilot data for a larger trial examining differences in the MIDCABG and conventional full sternotomy OPCAB procedures.
authors.affiliation: 1 Great Western Hospital, Swindon, UK.|2 University of Bristol, UK.
authors.forename: Julian J
authors.initials: JJ
authors.lastname: Nesbitt
authors.affiliation: 3 Yorkshire and Humber School of Surgery, Yorkshire, UK.
authors.forename: George
authors.initials: G
authors.lastname: Mori
authors.affiliation: 2 University of Bristol, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mason-Apps
authors.affiliation: 2 University of Bristol, UK.|4 Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
authors.forename: George
authors.initials: G
authors.lastname: Asimakopoulos
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D056346:Sternotomy / Q000379:methods; D013908:Thoracotomy / Q000379:methods
keywords: cardiothoracic surgery; coronary artery bypass graft; minimally invasive; off-pump; quality of life