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Biomedical subjects

V Falk

Publications and source records attributed to V Falk.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy.

BACKGROUND: The aim of this prospectively randomized study was to evaluate left ventricular hypertrophy and its regression after stentless versus conventional biological aortic valve replacement. METHODS AND RESULTS: From March 1996 through April 1998, 180 patients were prospectively selected; 106 patients received a stentless aortic valve (SAV), and 74 received a conventional stented bioprosthesis (CSB). Of these patients, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72.3 and 74.8 years, and there were no significant differences in left ventricular function, preoperative pressure gradients, and NYHA functional status. Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13.55 (CSB) mm (P=NS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (n=3 and 1 for SAV and CSB) was not valve related. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-diastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8(CSB) mm (P=NS) and decreased to 11. 8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m(2) at baseline (P=NS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m(2) (P<0.05). CONCLUSIONS: Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement but is significantly enhanced after SAV implantation. This possibly is due to improved transvalvular hemodynamics.

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PubMed1999

Early clinical results after stentless mitral valve implantation and comparison with conventional valve repair or replacement.

BACKGROUND: A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. METHODS AND RESULTS: Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69+/-8, 64+/-10, and 62+/-9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59+/-19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm(2). Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. CONCLUSIONS: One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

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PubMed1999

Pain and quality of life after minimally invasive versus conventional cardiac surgery.

BACKGROUND: The aim of this study was to evaluate pain and quality of life after minimally invasive cardiac operations in comparison with conventional cardiac operations. METHODS: From October 1996 to May 1997 a total of 338 patients were interviewed daily using standard scoring systems (myocardial revascularization, n = 160; mitral valve reconstruction or replacement, n = 58; aortic valve replacement, n = 120). RESULTS: Regarding ventricular function and intensive care and hospital stay, there were no significant differences between groups. Pain decreased until the seventh postoperative day in all patients. Patients with a lateral minithoracotomy (minimally invasive revascularization and mitral valve operations) had lower pain levels from the third postoperative day onward. There were no differences in quality of life, postoperative wound healing, or stability of the bony thorax. CONCLUSIONS: In cardiac operations overall pain levels are relatively low. After minimally invasive procedures with lateral minithoracotomy, earlier mobilization is possible because of a better stability of the bony thorax, resulting in lower pain levels.

Aged↗
PubMed1999

Stentless tricuspid valve replacement.

Stentless tricuspid valve replacement was performed in a 21-year-old patient with severe destructive tricuspid valve endocarditis resistant to medical therapy. Postoperative recovery was uneventful. Stentless atrioventricular valves are considered an additional treatment option besides stented valves or homograft implantations for severe right-sided endocarditis. Transvalvular hemodynamics are excellent, and right ventricular function can be preserved by suspending the valve at the papillary muscles.

Adult↗
PubMed1999

Transabdominal endoscopic computer-enhanced coronary artery bypass grafting.

BACKGROUND: Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. METHODS: A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left (n = 10) and right internal thoracic arteries (n = 5) was performed. Coronary anastomoses were performed remotely and unassisted. In an animal model the hemodynamic consequences of the approach were assessed. RESULTS: In all cadavers TCAB was achieved through three abdominal ports. Time for internal thoracic arteries harvest was 48+/-13 minutes (left) and 39+/-10 minutes (right). Intimal dissection was found in one graft. Time for anastomosis was 23+/-9 minutes and 27+/-10 minutes for the left anterior descending (n = 10) and right coronary artery (n = 5), respectively. All anastomoses were patent. Opening the diaphragm in living animals led to a decrease of systolic blood pressure by 30+/16 mm Hg, but resolved with appropriate treatment. CONCLUSIONS: TCAB is possible in cadavers using computer-enhanced telemanipulation technology. The transabdominal approach is a promising access for less invasive cardiac surgery.

Animals↗
PubMed1999

Quality of computer enhanced totally endoscopic coronary bypass graft anastomosis--comparison to conventional technique.

OBJECTIVE: Aims of the study were to develop an endoscopic technique to perform robot assisted coronary anastomoses, using a computer enhanced telemanipulator and to compare the quality of the anastomoses with those performed using a standard open technique. METHODS: A surgical telemanipulator with two instrument arms and a central videoscopic arm was used to perform remote endoscopic coronary artery bypass grafting on isolated porcine hearts. The end effectors and the videoscope were placed through three 10 mm port incisions. All anastomoses (Cx to LAD) were performed using a double armed 7-0 Prolene suture of 5 or 7 cm in length. All operations were performed remotely from the master console using ten times magnification, tremor filtering and 3:1 motion scaling. Initially 20 anastomoses were performed to develop and train the technique. Then, 20 robot-assisted anastomoses (group I) were compared with 20 anastomoses using a standard open parachute technique (group II). All anastomoses were checked for patency and leakage. Patency was confirmed by bench angiography. After fixation, all anastomoses were macroscopically evaluated for patency, intactness, alignment, intimal tears and dehiscence. Both angiographic and pathologic evaluations were performed with the examiners blinded to the technique of anastomosis. RESULTS: In the initial feasibility series, time for anastomosis was 18.2 +/- 9.1 min. All anastomoses were patent although minor stenoses were found in two and minor leakage was noted in five anastomoses. In the second series all anastomoses were patent, not leaking and showed a good run-off at angiography. Mean time for anastomosis in group I was 12.8 +/- 2.4 min as compared with 6.3 +/- 0.2 min in group II (P < 0.001), respectively. Macroscopic analysis demonstrated equal quality for both groups. There were no stenoses, no intimal tears and no dehiscences. All anastomoses had a normal alignment and intact suture lines. CONCLUSION: Using the Intuitive surgical telemanipulator, it is possible to remotely perform endoscopic coronary anastomoses with the same quality as with an open standard technique after a brief learning curve. This will enable true endoscopic coronary artery bypass grafting with a precision that has not been achieved with any other previously applied endoscopic technique.

Anastomosis, Surgical↗
PubMed1999

The evolution of minimally invasive valve surgery--2 year experience.

OBJECTIVES: The aim of the study was to evaluate the evolution of Port-Access minimally invasive mitral valve surgery to a robot assisted video assisted solo surgery approach. METHODS: One hundred and twenty-nine patients with non-ischemic mitral valve disease underwent 3D-video assisted mitral valve surgery via a 4 cm right lateral minithoracotomy using femoro-femoral bypass and endoaortic clamping. Transcranial Doppler and continuous transesophageal echocardiography were used to monitor placement and positional stability of the endoclamp. After the initial series (group I, n = 62), a simplified solo surgical technique using voice controlled robotic assistance for videoscope guidance was used in the last 67 patients (group II). RESULTS: After an initial learning curve and modifications of catheter design, the procedure could be steadily redefined and simplified. In the last 67 patients, the procedure was completed without the need for an additional assistant as 'solo surgery'. The mitral valve was repaired in 72 and replaced in all other patients. Duration of bypass and clamp time steadily improved during our study and in the most recent 67 patients average 107 +/- 34 and 48 +/- 16 min, respectively. The voice controlled robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning) provided a stable and precise video image with excellent exposure of all valvular and subvalvular structures. Hospital mortality was high in the early series (mean survival 88.7% at 804 +/- 35 days; 95% CI: 735-873) and partially procedure related (aortic dissection in two patients). In group II, hospital mortality has declined to 3.0% (mean survival 97.0% at 568 +/- 12 days; 95% CI: 553-600). CONCLUSION: Port-Access minimally invasive mitral valve surgery has evolved to be a reliable video assisted technique with reproducible results. Surgery can now be performed almost in the same time as with conventional techniques. Robotic assistance has enabled a solo surgery approach.

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PubMed1999

Indication and patient selection in minimally invasive and òff-pump' coronary artery bypass grafting.

BACKGROUND: The selection criteria to perform 'off-pump' coronary bypass (OPCAB) grafting are not well defined. The aim of this presentation is to outline the indications and the patient selection on the basis of 2 years experience with 572 OPCAB procedures. MATERIALS AND METHODS: From November 1996 minimally invasive coronary bypass grafting was performed in 406 patients using a limited minithoracotomy for single left anterior descending artery (LAD) revascularization (group A). In 166 patients full sternotomy and OPCAB grafting for single or multiple vessel revascularization was performed (group B). RESULTS: In group A the procedure could be performed 'off-pump' together with a limited thoracotomy in 406 out of 457 patients (88.8%) who were scheduled for single graft revascularization to LAD. Exposure and quality of the LAD was good in 308/406 (76.0%) of the patients. The decision for sternotomy was made for different preoperative characteristics of these patients: Obese female patients 16/457 (3.5%), angiographic evidence of an intramyocardial running LAD 6/457% (1.4%), diffusely diseased and small LAD 11/457 (2.4%) severe COPD 3/457 (0.7%), unstable angina 11/457 (2.4%), emergency revascularization after failed PTCA 4/457 (0.8%). In 315/406 (77.8%) of the minimally invasive direct coronary artery bypass (MIDCAB)-patients exposure and quality of the LAD was good, in 97/406 (22.2%) moderate or even bad. In the latter subgroup stenosis free anastomosis was reduced (86.5%) compared to the subgroup of good exposure and quality with 98.3%. In group B selection for sternotomy and 'off-pump' procedure was made in 117/166 (70.4%) patients with a normal preoperative status (stable angina, ejection fraction > 35%) and with coronary lesions amenable for beating heart surgery (proximal RCA lesion > 80%, not calcified and well defined POD and marginal branches). In 49/166 (29.5%) decision for 'off-pump' procedure was made on the basis of a potential risk for cardiopulmonary bypass (CPB) such as acute myocardial infarction in 10/166 (6.0%), reduced ventricular function with EF < 35 in 28/166 (16.9%), calcified ascending aorta 4/166 (2.4%) or concomitant diseases 7/166 (2.5). CONCLUSION: To maintain excellent results after single LAD revascularization using the MIDCAB-approach, appropriate patient selection is crucial. Indication for sternotomy and 'off-pump' single LAD revascularization should made in those patients excluded for MIDCAB and in patients scheduled for multiple vessel-CABG who are at high risk for CPB (concomitant pulmonary, renal, neurological diseases or severely impaired left ventricular dysfunction) and have suitable target coronary arteries in term of location and quality.

Adult↗
PubMed1999

Computer-enhanced mitral valve surgery: toward a total endoscopic procedure.

The aim of the study was to develop a computer-enhanced, video-assisted approach for mitral valve repair as a potential step toward a complete endoscopic procedure. In 10 patients with nonischemic mitral valve insufficiency, computer-enhanced telemetric mitral valve repair using the Intuitive surgical telemanipulation system was performed. A femorofemoral bypass was initiated using Port-Access (Heartport, Redwood City, CA) cannulation. A small minithoracotomy was made in the right 4th intercostal space, and a custom-made rib retractor was placed. The pericardium was opened manually, and four traction stay sutures were placed to enhance exposure. After endoaortic balloon clamping, the left atrium was opened and stabilized. The end-effectors were placed in the left atrium through two ports (3rd ICS and 6th ICS, midaxillary line). A 30 degrees three-dimensional (3D)-videoscope angled up was placed through the incision. Mitral valve repair was then performed remotely from the surgical console. This included inspection of the valve, leaflet resection, leaflet repair, and ring implantation. After completion of the repair and testing of the valve, the end effectors were withdrawn, and the left atrium was closed manually using standard endoscopic instruments (Heartport). In all but 1 patient, successful repair, including quadrangular resection, chordal shortening, Whooler-plasty, and Alfieri-plasty, could be accomplished using the computer-enhanced telemanipulation system. A partial ring was implanted in 6 patients and a complete ring was implanted in 3 patients, respectively. Time for surgery, CPB, and clamp time were 170 to 330 minutes (median, 185 minutes), 140 to 220 minutes (median, 149 minutes), and 78 to 133 minutes (median, 94 minutes), respectively. In one patient, intraoperative transesophageal echocardiography (TEE) showed insufficient repair, a second surgery was performed via an enlarged left thoracotomy. One patient with recurrent mitral insufficiency had to have a second surgery on postoperative day 3 for a torn-out ring. Median time of hospitalization was 8 days. At 3 months follow-up (completed in 7 patients), all patients had improved clinically. Computer-enhanced mitral valve repair is feasible and can be performed with good functional results. The telemanipulation system offers the potential for true endoscopic mitral valve repair. However, surgical time is prolonged, and a learning curve has to be overcome.

Aged↗
PubMed1999

Coronary bypass grafting without cardiopulmonary bypass--technical considerations, clinical results, and follow-up.

BACKGROUND: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. METHODS: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Group B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis. RESULTS: In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1% as confirmed by angiography. In group B, 25 patients had single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1%), postoperative low output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1%). Mortality was 1.1%. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%. CONCLUSION: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.

Cardiopulmonary Bypass↗
PubMed1999

Effectiveness of different anticalcification treatments for stentless aortic bioprostheses.

BACKGROUND: New anticalcification treatments for stentless bioprostheses have not yet been compared independently. MATERIAL AND METHODS: The No-reacts (Biocor), AOA (Medtronic Freestyle), and BiLinx (SJM Toronto SPV II) methods were studied and compared with a control group. Aortic valve leaflet and aortic root tissue was subcutaneously implanted in 60 male, 21-days-old Sprague-Dawley rats. Calcium content was quantified using inductively coupled plasma spectrophotometry. RESULTS: No infections occurred. Low levels of calcium were measured in aortic valve leaflet tissue for all methods (0.4 to 1.5 mg/g dry weight) in comparison to the control group (225 mg/g), p < 0.01. Calcification of aortic root tissue was low in the Bilinx group (2.4 mg/g, p < 0.01), whereas calcium levels were high in all other groups (104 to 127 mg/g). CONCLUSIONS: Calcification of aortic valve leaflets was significantly reduced by all new anticalcification treatments, whereas aortic root calcification was only reduced by inhibition of cellular calcification (BiLinx). Maximum anticalcification properties of both leaflet and aortic root are important, as these are considered a functional unit in stentless bioprostheses.

Aluminum Chloride↗
PubMed1999

Quadrileaflet stentless mitral valve replacement.

BACKGROUND: The study evaluates clinical results and hemodynamic parameters one year after implantation of a stentless quadrileaflet mitral valve (QMV). METHODS: Since August 1997 28 patients received the QMV, patient age was 69 +/- 8 years; 13 had predominant mitral stenosis and 15 incompetence, preoperative NYHA functional class was III or IV and cardiac index 1.8 +/- 0.6 L/min/m2. RESULTS: Surgery was performed using a conventional (25) or a minimally invasive approach (3). 20 patients received a medium and 8 a large-size prosthesis, crossclamp time was 58 +/- 19 min. Additional procedures were myocardial revascularization in four, tricuspid repair in two, and left-atrial radiofrequency ablation to restore sinus rhythm in six patients. Perioperative mortality (1) was not valve-related. All other patients were discharged on time. At postoperative, 6-, and 12-months follow-up mean transvalvular pressure gradients were 4.2 +/- 1.5 / 4 +/- 0.9/ 3.8 +/- 1.4 mmHg and mitral valve orifice area index was 1.5 +/- 0.3 / 1.6 +/- 0.3 / 1.6 +/- 0.4, NYHA class was I or II. CONCLUSIONS: The QMV is well suited for mitral valve replacement. The anulo-ventricular continuity is preserved and the QMV function resembles native mitral valve function. If its performance is maintained in the long term the QMV may be the mitral prosthesis of choice.

Aged↗
PubMed1999

Quality assessment in minimally invasive coronary artery bypass grafting.

OBJECTIVES: The most important determinant for the success of minimally invasive coronary artery bypass grafting (MIDCAB) is the quality and long-term patency of the graft and anastomosis. Intra and postoperative quality assessment is important to confirm the safety and effectiveness of minimally invasive techniques. METHODS: From January to December 1998 MIDCAB was performed in 246 patients using a limited minithoracotomy for single left anterior descending artery (LAD) revascularization. According to our standard protocol quality assessment of the graft and anastomosis consisted of intraoperative flow measurement, early postoperative angiography and follow-up angiography after 6 months. RESULTS: Intraoperative flow measurement was performed in patients with anastomoses unsuitable for coronary probing (75/246, mean flow of 34.3 +/- 17.7 ml/min). Early patency was confirmed by intraoperative monoplane angiogram in 37/246 (15.0%) patients and by postoperative multiplan angiography in 205/246 (83.3%). Early patency rate was 98.0%. Six months follow-up showed a patency rate of 97.5% (one occluded graft, two severe and two moderate stenoses at the anastomotic site). Eighty-nine percent of the patients were in a CCS angina class I, 11% in class II, respectively. Six months mortality was 0.8%. Re-intervention had to be performed in 5/116 (4.3%). CONCLUSIONS: A standardized protocol for quality assessment is mandatory for MIDCAB surgery. The proposed algorithm serves to ensure the safety and effectiveness of this new technique. Our recent series document an excellent outcome of the MIDCAB approach. Postoperative multiplan angiography is the only technique to achieve valid information about the quality of graft and anastomosis.

Blood Flow Velocity↗
PubMed1999

Regression of left ventricular hypertrophy after stentless versus conventional aortic valve replacement.

The goal of this study was to analyze regression of left ventricular hypertrophy after randomization to conventional biological versus stentless aortic valve replacement. Stentless (Freestyle, Toronto, n = 106) or conventional biological aortic valves (Carpentier-Edwards, n = 74) were evaluated prospectively. Preoperatively there were no differences with regard to aortic valve pathology, left ventricular function, and pressure gradients between the two patient groups. The patient annulus index (13.55 vs. 13.46 mm; NS) measured intraoperatively was used as baseline for further comparison. Postoperatively, left ventricular mass index was 213+/-77 g/m2 (stentless) compared with 202+/-72 (conventional group) g/m2 (NS), whereas after 6 months it was 141+/-41 g/m2 in the stentless and 170+/-43 g/m2 in the conventional group (P<.05). Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement. Nevertheless, the use of stentless bioprostheses leads to a significant enhancement, which may result in a reduction of the cardiac risk profile for the patient.

Aged↗
PubMed1999

Stentless mitral valve replacement using the quattro valve.

This study analyzed early clinical results after stentless mitral valve (Quadrileaflet Mitral Valve (QMV)/Quattro) implantation. A total of 28 patients have received a Quattro valve since August 1997. Patient age was 69+/-8 years; the underlying disease was mitral incompetence (14) and stenosis (13). Preoperative New York Heart Association functional class was 3.2+/-0.4 and cardiac index was 1.8+/-0.6. Mean cross-clamp duration was 58+/-19 minutes. Twenty patients received a 28-mm prosthesis, and eight patients received a 30-mm prosthesis. Four patients had myocardial revascularization, two had tricuspid valve repair, and six had radiofrequency ablation therapy to restore sinus rhythm. Mortality (1) was nonvalve related. Reoperation was necessary in two patients for posterior paravalvular leakage (1) and for functional stenosis (1). Echocardiography showed satisfactory hemodynamic function. By stentless mitral valve implantation the annuloventricular continuity is preserved to stabilize left ventricular function. The Quattro valve resembles native mitral valve function and is well suited for mitral valve replacement.

Aged↗
PubMed1999

Endoscopic coronary artery bypass grafting on the beating heart using a computer enhanced telemanipulation system.

OBJECTIVE: To develop a technique for computer enhanced endoscopic arterial bypass grafting on the beating heart in an experimental canine model. METHODS: Mongrel dogs (30-35 kg) were used. After single lung ventilation of the right lung was initiated the dogs were placed to the right. The videoscope and the end-effectors of the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, CA) were introduced through three ports. Surgery was performed remotely from the console (motion scaling 3:1). After harvesting of the internal thoracic artery (ITA) and preparation of its distal end, the Endostab, a newly developed endoscopic stabilizer, was introduced through an additional port. The anterior wall of the heart was stabilized and the collateral branch (RC) of the left anterior descending artery (LAD) was ligated proximally and distally. The arteriotomy was made and the ITA-graft anastomosed to the RC. The animals were sacrificed and the grafts were checked for patency using bench angiography. RESULTS: In two of five dogs total endoscopic beating heart bypass grafting, including ITA harvest, stabilization, arteriotomy and performance of the anastomosis, was successfully performed using computer enhanced technology and a new endoscopic stabilizer. In two dogs the procedure was completed with femoro-femoral cardiopulmonary bypass (CPB) support on the beating or fibrillating heart, respectively. One dog expired due to VT. Hemodynamically, endoscopic stabilization was well tolerated. All four grafts were patent despite a target vessel diameter of less than 1 mm. CONCLUSION: The endoscopic stabilizer can sufficiently immobilize the heart to enable endoscopic beating heart coronary artery bypass grafting by means of a computer controlled instrumentation system.

Animals↗
PubMed1999

Comparison of MIDCAP versus conventional CABG surgery regarding pain and quality of life.

BACKGROUND: This prospective clinical trial focuses on pain and quality of life (QOL) after minimally invasive direct coronary artery bypass (MIDCAB) grafting versus conventional coronary artery bypass grafting (CABG). METHODS: Group A consisted of 65 consecutive MIDCAB patients using an anterolateral mini-thoracotomy and the "off-pump" technique. Group B consisted of 95 computer-matched patients who underwent conventional CABG with cardiopulmonary bypass (CPB). Pain was graduated using the visual analog scale (VAS), and the verbal rating scale (VRS) [Troidl 1990]. QOL was evaluated at the time of discharge and three months after surgery using modified Nottingham Health Questionnaires that separate physical, social, activity, emotional, pain, and sleeping conditions. RESULTS: Postoperative pain was higher after MIDCAB on postoperative day (POD) 1 (p< 0.002). From POD 4 onwards MIDCAB patients had less pain compared with the conventional group (p<0.04). MIDCAB patients required less pain medication from POD 4 onwards (p<0.05). QOL was significantly better in the MIDCAB group on POD 7 for physical (p< 0.038), activity (p< 0.016), pain (p< 0.041), and sleep (p<0.038) conditions. The three-month questionnaire showed significantly better levels for MIDCAB patients regarding physical (p< 0.03) and pain (p< 0.001) conditions, and a trend for activity (p< 0.08) and emotional (p<0.08) conditions. CONCLUSION: Compared to patients undergoing conventional surgery, MIDCAB patients suffer more pain in the first three postoperative days, probably as a result of the lateral thoracotomy. From POD 4 onwards, MIDCAB patients are significantly better, experiencing less pain and showing better physical, activity, and sleeping conditions even three months after surgery. This can be attributed to the absence of median sternotomy and/or the avoidance of cardiopulmonary bypass.

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