Postoperative recovery in children after minimum versus full-length sternotomy

Background. Minimal access incisions for pediatric cardiac surgery have bee n reported to hasten postoperative recovery. This prospective study compare d recovery after a minimum versus full-length sternotomy for repair of atri al septal defects in children. Methods. We studied 35 children undergoing atrial septal defect repair usin g a full-length sternotomy (n = 18) or ministernotomy (n = 17) according to the surgeon's preference. All children were managed according to an establ ished clinical practice guideline. Intraoperative comparisons included pati ent demographics, bypass and cross-clamp times, and, as a measure of stress response, epinephrine, norepinephrine, and lactate levels at six time inte rvals throughout the surgical procedure. Postoperative comparisons included pain scores at 6, 12, and 24 hours, frequency of emesis, analgesic require ments, respiratory rate and gas exchange, and length of intensive care unit and total hospital stay. Nurse and parent assessment scores of overall rec overy were constructed using visual analog and Likert scales. Results. No significant differences between mini- versus full-length sterno tomy were detected for the measured outcome variables. No adverse outcomes were detected. Conclusions. In this prospective study, a ministernotomy did not enhance po stoperative recovery, and the primary advantage appears to be an improved c osmetic result. (C) 2000 by The Society of Thoracic Surgeons.