Upper extremity neuropathies after cardiac surgery.

Area of Science:

• Neurology
• Cardiovascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a prevalent surgical procedure.
• Significant postoperative morbidity can occur following CABG.
• Unexplained neuropathies have been occasionally observed in patients post-CABG.

Purpose of the Study:

• To investigate the incidence and characteristics of postoperative neuropathy in patients undergoing median sternotomy for cardiac surgery.
• To identify potential risk factors associated with the development of neuropathy.

Main Methods:

• Prospective study of 53 patients undergoing standard median sternotomy for cardiac surgery.
• Detailed sensory and motor testing.
• Intraoperative measurement of sternal retraction distance and cardiopulmonary bypass duration.
• Electromyography and nerve conduction evaluations in a subset of patients.

Main Results:

• Twenty patients (37.7%) developed postoperative motor and sensory neuropathies, predominantly affecting the ulnar nerve.
• Five patients showed evidence of brachial plexus injury on electrodiagnostic testing.
• Average symptom duration was 2.3 months, with some experiencing long-term unresolved symptoms.

Conclusions:

• Postoperative neuropathy, potentially involving the brachial plexus, is a notable complication of median sternotomy in cardiac surgery.
• Factors such as prior neuropathies, extensive sternal retraction, and prolonged cardiopulmonary bypass may predispose patients to this injury.