Large vessel - sternum adhesion after cardiac surgery; a risk-factor analysis
Takashi Yamauchi1, Yuji Miyamoto, Hajime Ichikawa
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
Surgery Today
|June 24, 2006
Summary
Restenotomy after cardiac surgery carries risks. Dense adhesions between large vessels and the sternum, identified by extracardiac conduits and large mediastinal vessels, predict potential injury during re-entry.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Restenotomy is often necessary after initial cardiac surgery.
- Dense adhesions between great vessels and the sternum pose significant risks during re-entry.
Purpose of the Study:
- To evaluate clinical outcomes of resternotomy in patients with dense adhesions.
- To identify morphologic predictors of these adhesions.
Main Methods:
- Retrospective analysis of 67 patients undergoing median resternotomy (2000-2003).
- Preoperative computed tomography (CT) scans were used for morphologic assessment.
- Multivariate logistic regression identified predictive features.
Main Results:
- 29.9% of patients had direct adhesions.
- Vessel injury occurred in 10% of cases with adhesions, leading to one death.
- Extracardiac conduits and high mediastinal occupying rate of great vessels predicted adhesions.
Conclusions:
- Extracardiac conduits and large ascending aorta/pulmonary artery relative to mediastinal space are risk factors for injury.
- These morphologic features aid in risk assessment before resternotomy.
