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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1998 October;39(5):673-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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