Anterior thoracotomy wound complications in minimally invasive direct coronary artery bypass

Background. The minimally invasive anterior thoracotomy for beating heart coronary bypass offers a modest 10-cm incision and avoids the morbidity of extracorporeal circulation. This study examines minimally invasive direct coronary artery bypass (MIDCAB) wound complications and contributing comorbid factors. Methods. A retrospective, single-institution review of 165 consecutive MIDCAB cases performed between March 1996 and August 1999 examined all wound abnormalities. Two surgeons performed all cases. Results. Wound complications occurred in 15 patients (9.1%), including three (1.8%) incisional hernias, four (2.4%) superficial dehiscences, three (1.8%) wound infections, three (1.8%) chronic pain syndromes, and two (1.2%) seromas. Two patients with incisional hernias required operative repair. The remaining wound abnormalities responded to conservative therapy. Two chronic pain syndrome cases resolved spontaneously, but the third required advanced pain management. In contrast to MIDCAB, the sternotomy wound complications proved significantly less prevalent (n = 5259, 1.1% vs 9.1%, p< 0.005). Conclusions. Although MIDCAB offers several advantages over standard approaches, these data suggest that anterior thoracotomy wound complications are not insignificant and may be underestimated by those exploring minimally invasive options.