Document Detail


An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial.
MedLine Citation:
PMID:  22944093     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our objective was to compare off-pump coronary artery bypass surgery carried out via a left anterolateral thoracotomy (ThoraCAB) or via a conventional median sternotomy (OPCAB).
BACKGROUND: Recent advances in minimally invasive cardiac surgery have extended the technique to allow complete surgical revascularization on the beating heart via thoracotomy.
METHODS: Patients undergoing nonemergency primary surgery were enrolled between February 2007 and September 2009 at 2 centers. The primary outcome was the time from surgery to fitness for hospital discharge as defined by objective criteria.
RESULTS: A total of 93 patients were randomized to off-pump coronary artery bypass surgery via a median sternotomy (OPCAB) and 91 to off-pump coronary artery bypass surgery via a left anterolateral thoracotomy (ThoraCAB). The surgery was longer for patients in the ThoraCAB group (median, 4.1 vs 3.3 hours) and there were fewer with more than 3 grafts (2% vs 17%). The median time from surgery to fitness for discharge was 6 days (interquartile range, 4-7) in the ThoraCAB group versus 5 days (interquartile range, 4-7) in the OPCAB group (P = .53). The intubation time was shorter, by on average 65 minutes, in the ThoraCAB group (P = .017), although the time in intensive care was similar (P = .91). Pain scores were similar (P = .97), but more analgesia was required in the ThoraCAB group (median duration, 38.8 vs 35.5 hours, P < .001; tramadol use, 66% vs 49%, P = .024). ThoraCAB was associated with significantly worse lung function at discharge (average difference, -0.25 L, P = .01) but quality of life scores at 3 and 12 months were similar (P = .52). The average total cost was 10% higher with ThoraCAB (P = .007).
CONCLUSIONS: ThoraCAB resulted in no overall clinical benefit relative to OPCAB.
Authors:
Chris A Rogers; Katie Pike; Gianni D Angelini; Barnaby C Reeves; Mattia Glauber; Matteo Ferrarini; Gavin J Murphy
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-08-31
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  146     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-22     Completed Date:  2013-09-27     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  306-16.e1-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN77366282
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MeSH Terms
Descriptor/Qualifier:
Aged
Airway Extubation
Analgesics / therapeutic use
Coronary Artery Bypass, Off-Pump / adverse effects,  economics,  methods*,  mortality
England
Female
Health Care Costs
Health Resources / economics,  utilization*
Humans
Intensive Care Units
Italy
Length of Stay
Lung / physiopathology
Lung Diseases / etiology,  physiopathology
Male
Middle Aged
Pain, Postoperative / etiology,  prevention & control
Patient Discharge
Quality of Life
Sternotomy* / adverse effects,  economics,  mortality
Thoracotomy* / adverse effects,  economics,  mortality
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
G0800800//Medical Research Council; //British Heart Foundation
Chemical
Reg. No./Substance:
0/Analgesics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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