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Effect of sternotomy direction on the incidence of inadvertent pleurotomy
1Department of Cardiac Surgery, Mayo Medical Center, Rochester, Australia.
Objective:
Median sternotomy was performed by 2 different techniques in order to determine whether there was a difference in the incidence of inadvertent pleural entry.
Experimental Design:
Patients were prospectively evaluated and reviewed at a mean follow-up interval of 8.2 months.
Patients And Methods:
Ninety five consecutive patients underwent primary sternotomy at a single tertiary referral center.
Measures:
Planned outcome measures included, incidence of pleural entry, length of hospitalization, and chest tube site related postoperative morbidity.
Results:
Group 1 (n=49) had sternotomy undertaken from the sternal notch proceeding downwards. Group 2 (n=46) underwent sternotomy performed from the xiphoid upwards. Mediastinal evaluation revealed a significant reduction in the incidence of pleural violation for group 1 (3) versus group 2 (11) (p=0.014). This difference was not found to be surgeon specific.
Conclusions:
Sternotomy undertaken from the sternal notch proceeding downwards is shown to be associated with a reduced incidence of inadvertent pleural entry. Potential advantages for this approach also include reduced respiratory morbidity, less chest tube site complications and a trend to reduced length of hospitalization.
