TECHNICAL NOTES  CARDIAC PAPERS 

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

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.