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Surgical considerations in patients undergoing repeat median sternotomy
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1975
Summary
Repeat median sternotomy for valve disease can be complex. Hemorrhage is the most serious complication, but an organized approach helps manage it, ensuring patient survival during repeat sternotomy procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Repeat median sternotomy is frequently performed for progressive rheumatic valvular disease or prosthetic complications.
- Patients undergoing repeat sternotomy often have adhesions from prior surgeries, increasing procedural risks.
Purpose of the Study:
- To evaluate the complications and management strategies associated with repeat median sternotomy.
- To assess the incidence and nature of complications in patients undergoing multiple sternotomies.
Main Methods:
- A retrospective review of 122 repeat median sternotomy incisions in 100 consecutive patients.
- Analysis of patient history, reoperation indications, and post-operative outcomes.
Main Results:
- The most frequent indication for repeat sternotomy was progressive rheumatic valvular disease or prosthetic issues.
- Complications included hemorrhage (operative and postoperative), seroma, dehiscence, wound infection, and hematoma.
- Hemorrhage was the most serious complication, leading to the only operative death, though seven other patients survived significant hemorrhage.
Conclusions:
- Repeat median sternotomy carries risks, with hemorrhage being the most critical concern.
- An organized approach to managing adhesions and potential massive hemorrhage is crucial for successful outcomes in repeat sternotomy patients.