Anterior thoracotomy wound complications in minimally invasive direct coronary artery bypass

Background. The minimally invasive anterior thoracotomy for beating heart c oronary bypass offers a modest 10-cm incision and avoids the morbidity of e xtracorporeal circulation. This study examines minimally invasive direct co ronary artery bypass (MIDCAB) wound complications and contributing comorbid factors. Methods. A retrospective, single-institution review of 165 consecutive MIDC AB cases performed between March 1996 and August 1999 examined all wound ab normalities. Two surgeons performed all cases. Results. Wound complications occurred in 15 patients (9.1%), including thre e (1.8%) incisional hernias, four (2.4%) superficial dehiscences, three (1. 8%) wound infections, three (1.8%) chronic pain syndromes, and two (1.2%) s eromas. Two patients with incisional hernias required operative repair. The remaining wound abnormalities responded to conservative therapy. Two chron ic pain syndrome cases resolved spontaneously, but the third required advan ced pain management. In contrast to MIDCAB, the sternotomy wound complicati ons proved significantly less prevalent (n = 5259, 1.1% vs 9.1%, p < 0.005) . Conclusions. Although MIDCAB offers several advantages over standard approa ches, these data suggest that anterior thoracotomy wound complications are not insignificant and may be underestimated by those exploring minimally in vasive options. (C) 2000 by The Society of Thoracic Surgeons.