Influence of median sternotomy on the psychosomatic outcome in coronary artery single-vessel bypass grafting

Objectives: New less invasive surgical techniques for the treatment of coro nary artery single-vessel disease have been developed by either avoiding me dian sternotomy or cardiopulmonary bypass or both, however, until now no pr ospective randomized trial has been carried out to compare these techniques to the conventional approach with special respect to the psychosomatical e ffects. Methods: In a prospective randomized trial four different surgical techniques were compared. Group 1: conventional technique (median sternotom y, cardiopulmonary bypass) in ten patients (eight male, two female, age 59. 6 +/- 11.0 years); Group 2. off-pump coronary artery bypass with median ste rnotomy in nine patients (six male, three female, age 65.7 +/-. 11.1 years) ; Group 3: lateral minithoracotomy and cardiopulmonary bypass in eight pati ents (five male, three female, age 62.3 +/- 9.9 years). Group 4: off-pump p rocedure and lateral minithoracotomy in nine patients (eight male, one fema le. age 63.8 +/- 11.3 years). All patients due to coronary artery single-ve ssel disease. The tests used for psychosomatic situation were post-traumati c stress disorders scale, pain behavior rating scale, pain visual analog sc ale, and 6' walking-distance. For detection of false results due to surgica l technical failures 3-month follow-up was undertaken including echocardiog raphy and coronary angiogram. Results. There were no deaths or major compli cations. Operative time was longer in lateral minithoracotomy procedures, b ut intensive care unit stay and hospitalization were equal in all groups. P ain visual analog scale and pain behavior rating scale showed a peak on pos t-operative day 4 in median sternotomy procedures. Post-traumatic stress di sorder scale revealed higher values on post-operative day 4 and equalizing with lateral minithoracotomy procedures 1 month post-operatively. six-minut es walking distance on post-operative day 4 was longer in the soup with lat eral minithoracotomy. Three-month follow-up revealed patency of all grafts. Conclusions: Even if surgery is successful in all procedures, operative ti me is longer in lateral minithoracotomy procedures without compromising int ensive care unit stay and hospital stay. More pain with multiple post-traum atic stress disorders is related to median sternotomy, and post-operative c onvalescence is superior for lateral minithoracotomy procedures. (C) 1999 E lsevier Science B.V. All rights reserved.