Effect of coexisting Paget's disease on coronary artery bypass operations

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Skeletal Pathology

Background:

• Paget's disease of the sternum is a rare condition.
• It presents unique surgical challenges during sternotomy and internal mammary artery harvesting due to sternal thickening and adhesions.

Observation:

• Sternotomy in patients with sternal Paget's disease can be complicated by thickened bone and adhesions.
• Saphenous vein grafts may require repeat revascularization due to degeneration, particularly in younger patients.

Findings:

• Repeat sternotomy poses significant risks. Alternative surgical approaches like thoracotomy or less invasive techniques (balloon/stent) may be beneficial.
• Careful consideration of graft types and surgical strategy is crucial for long-term outcomes.

Implications:

• For patients with sternal Paget's disease, alternative surgical approaches should be considered to mitigate risks associated with repeat sternotomies.
• Exploring noninvasive or less invasive options can improve patient management and long-term prognosis.