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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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TECHNICAL NOTES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1998 October;39(5):673-6
Effect of sternotomy direction on the incidence of inadvertent pleurotomy
Pick A., Dearani J., Odell J.
From the Department of Cardiac Surgery Mayo Medical Center Rochester, Australia
Objective. Median sternotomy was performed by 2 different techniques in order to determine whether there was a difference in the incidence of inadvertent pleural entry.
Experimental design. Patients were prospectively evaluated and reviewed at a mean follow-up interval of 8.2 months.
Patients and methods. Ninety five consecutive patients underwent primary sternotomy at a single tertiary referral center.
Measures. Planned outcome measures included, incidence of pleural entry, length of hospitalization, and chest tube site related postoperative morbidity.
Results. Group 1 (n=49) had sternotomy undertaken from the sternal notch proceeding downwards. Group 2 (n=46) underwent sternotomy performed from the xiphoid upwards. Mediastinal evaluation revealed a significant reduction in the incidence of pleural violation for group 1 (3) versus group 2 (11) (p=0.014). This difference was not found to be surgeon specific.
Conclusions. Sternotomy undertaken from the sternal notch proceeding downwards is shown to be associated with a reduced incidence of inadvertent pleural entry. Potential advantages for this approach also include reduced respiratory morbidity, less chest tube site complications and a trend to reduced length of hospitalization.