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Three or more median sternotomies for patients with valve disease: role of computed tomography

Kiyofumi Morishita1, Nobuyoshi Kawaharada, Jhoji Fukada

  • 1Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. kmori@sapmed.ac.jp

The Annals of Thoracic Surgery
|May 9, 2003
PubMed

Insights

Computed tomographic (CT) scans significantly reduce complications and mortality in patients undergoing repeat sternotomies for valve operations. Preoperative CT imaging guides safer surgical strategies for these complex procedures.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Repeat sternotomies for valve operations carry risks of complications and mortality.
  • Assessing retrosternal adhesions before re-entry is crucial for patient safety.

Purpose of the Study:

  • To evaluate the impact of computed tomographic (CT) scan-guided median sternotomies on resternotomy-related complications and early mortality.
  • To determine if preoperative CT imaging improves outcomes in patients undergoing third or fourth sternotomies for valve replacement.

Main Methods:

  • A retrospective study of 90 patients undergoing third or fourth sternotomies for valve replacement.
  • Patients were divided into a CT group (n=64) with preoperative CT scans and a no-CT group (n=26).
  • Outcomes including hospital death and sternotomy-related injury were compared between groups.

Main Results:

  • The CT group had significantly lower hospital mortality (6% vs. 23%, p=0.0309) and sternotomy-related injury rates (3% vs. 19%, p=0.0198).
  • Preoperative CT identified 8 high-risk patients who benefited from femorofemoral bypass before sternotomy.
  • Fourth sternotomy was a predictor of resternotomy-related injury (OR=4.31).

Conclusions:

  • Preoperative CT scans provide vital information on retrosternal adhesions, enabling safer surgical planning.
  • Strategies like femorofemoral cannulation before sternotomy can mitigate risks in high-risk patients.
  • Third and fourth sternotomies can be performed safely with appropriate preoperative assessment and surgical strategy.
Abstract

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