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.
Insights
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.
Purpose:
To study the clinical results of resternotomy in patients with dense and direct adhesion between the large vessels and the sternum, and define the morphologic features of the adhesion.
Methods:
Between 2000 and 2003, 67 patients with a history of cardiac surgery underwent median resternotomy. We studied each patient's profile and the measurements taken from preoperative computed tomography scans. We then conducted multivariate logistic regression analysis to determine the predictive morphologic features of adhesion between the large vessels and the sternum in these 67 patients.
Results:
Twenty (29.9%) of the 67 patients had direct adhesion between the large vessels and the sternum. Sternal re-entry was performed without injury to the large vessels in 18 (90%) but the aorta was injured in 2 (10%) patients, resulting in catastrophic hemodynamic disorder and operative death in one. Multivariate logistic regression analysis revealed that an extracardiac conduit and a high occupying rate of the aorta and pulmonary artery in the mediastinal space were significant morphologic factors.
Conclusion:
The morphologic features of large vessels to sternal dense adhesion as possible risk factors for injury to the large vessels are the presence of an extracardiac conduit and a large ascending aorta or pulmonary artery in relation to the mediastinal space.
