10. ANTERIOR THORACOTOMY WOUND COMPLICATIONS IN MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB)
Peter C. Ng, Arlene N. Chua, Melvin S. Swanson, W. Randolph Chitwood, Jr.*, Joseph R. Elbeery*
East Carolina University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery
Greenville, North Carolina, USA
BACKGROUND
The minimally invasive left anterior thoracotomy for beating heart coronary bypass offers patients a modest 10 cm incision and avoids the morbidity of extracorporeal circulation. This study was designed to examine MIDCAB patients and evaluate the wound-associated morbidity of the anterior thoracotomy.
METHODS AND RESULTS
A retrospective, single institution review of 144 consecutive MIDCAB cases performed between March 1996 and April 1999 examined all wound abnormalities. All cases were performed by the same surgeon. Wound complications occurred in 14 (9.7%). This included 3 (2.1%) incisional hernias, 6 (4.2%) superficial dehiscences, 3 (2.1%) chronic pain syndromes and 2 (1.4%) seromas. Two patients with incisional hernias underwent operative repair. The remaining wound abnormalities responded to conservative therapy and resolved in 1 to 5 months. The chronic incisional pain resolved spontaneously in two cases, but the third required advanced pain management and nerve block. In comparison, the combined superficial and deep wound complication rate for median sternotomy in the same institution (n=5259) equaled 1.1% (significantly less than MIDCAB incisions, FisherÂ’s Exact Test, P<0.0005).
CONCLUSION
Although this method offers several advantages over standard approaches, these data suggest that wound complications are a significant problem in the MIDCAB anterior thoracotomy and may be underestimated by those exploring minimally invasive options.
