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Thoracic computed tomography prior to redo coronary surgery
J Cremer1, O E Teebken, A Simon
1Department of Cardiovascular Surgery, Christian-Albrechts-University, Kiel, Germany.
Insights
Computed tomography (CT) scans improve preoperative assessment for redo coronary surgery, identifying risks and facilitating safer sternum reopening. This reduces the need for preventive measures like femoral vessel exposure.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Thoracic Surgery
Background:
- Median resternotomy in coronary artery bypass grafting (CABG) reoperations carries a risk of injury to retrosternal structures.
- Preoperative assessment is crucial for mitigating these risks.
Purpose of the Study:
- To evaluate the utility of computed tomography (CT) in assessing retrosternal structures before redo coronary surgery.
- To improve the safety of median resternotomy in repeat CABG procedures.
Main Methods:
- Retrospective analysis of thoracic CT scans from 99 patients undergoing coronary reoperations.
- Assessment of retrosternal cardiovascular structures, ascending aorta condition, and sternal abnormalities.
Main Results:
- Detailed measurements of distances between the sternum and the aorta/right ventricle were obtained.
- Ascending aorta calcification was identified in 56 patients.
- Despite close proximity in some cases, safe resternotomy was achieved, though innominate vein injury occurred in two patients.
Conclusions:
- Thoracic CT scanning provides a detailed preoperative assessment for redo coronary surgery.
- CT facilitates safer sternum reopening and may reduce the need for routine preventive femoral vessel exposure or lateral thoracotomies.
Objective:
Median resternotomy in coronary redo surgery represents a specific risk for injury of adjacent retrosternal structures. Aiming at improved preoperative evaluation of retrosternal structures, computed tomography (CT) techniques were routinely applied in redo cases.
Methods:
Of 99 patients undergoing coronary reoperations since April 93, thoracic CT scans were retrospectively analyzed for retrosternal vicinity of cardiovascular structures, condition of the ascending aorta and structural abnormalities of the sternum.
Results:
The minimal median distance between the posterior sternum surface and the anterior aortic wall was measured at 1.9 +/- 0.9 cm, whereas the mean closest distance to the anterior right ventricular wall was 0.4 +/- 0.5 cm. In 28 cases, the distance between sternum and aorta was smaller than or equal to 1 cm. No measurable distance between the sternum and the right ventricle was noted in 41 patients. Calcification of the ascending aorta became obvious 56 times. With respect to potential injury of the ascending aorta or the right ventricle, a safe reentry by resternotomy was facilitated in all cases. However, following complete sawing, the innominate vein became injured during retrosternal dissection in two cases. Preventive femoral vessel exposure was not performed and urgent femoral cannulation (n = 1) was infrequent.
Conclusions:
Thoracic CT scanning prior to redo coronary surgery allows for detailed assessment of retrosternal relations and facilitates reopening of the sternum. Preventive femoral vessel exposure and lateral thoracotomies may be avoidable in many cases.