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Published on: September 15, 2023
Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis
Mehmet Senel Bademci1, Gokhan Ocakoglu2, Cemal Kocaaslan1
1Department of Cardiovascular Surgery, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey.
Insights
Coronary artery bypass grafting (CABG) causes retrosternal narrowing and brings the pulmonary artery closer to the sternum. Surgeons should exercise caution during repeat median sternotomy due to these anatomical changes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Imaging
- Anatomical Studies
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Post-CABG adhesions can alter retrosternal anatomy.
- Understanding these changes is crucial for surgical safety.
Purpose of the Study:
- To evaluate anatomical deformations in the retrosternal area after CABG.
- To compare retrosternal structures between patients with and without prior CABG.
- To assess the impact of adhesions on major vascular structures.
Main Methods:
- Retrospective, single-center study.
- 40 patients with prior CABG and 40 controls.
- Contrast-enhanced chest CT and statistical shape analysis.
Main Results:
- Significant differences in retrosternal anatomy between groups (P<0.001).
- Pulmonary artery significantly closer to the midsternal line in the CABG group (P=0.013).
- Ascending aorta also closer, but not statistically significant.
Conclusions:
- CABG leads to retrosternal narrowing.
- The pulmonary artery is positioned closer to the sternum post-CABG.
- Increased caution advised for repeat median sternotomy due to potential vascular injury.
Introduction:
In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG).
Methods:
This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined.
Results:
There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05).
Conclusions:
Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.
