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At least 325 records · Page 18Linked to original sources
PubMed2005

Composite bilateral internal thoracic artery grafts via standard sternotomy for lateral wall revascularization in conscious patients.

BACKGROUND: A new technique has been developed that permits complete arterial revascularization of the lateral wall of the heart using in situ bilateral internal thoracic artery grafts in awake patients. This technique, performed without cardiopulmonary bypass or mechanical ventilation, creates the least invasive revascularization method for the lateral wall of the heart yet described. METHODS: In 4 patients, double or triple vessel coronary artery bypass grafting was performed without general anesthesia. A high thoracic epidural anesthesia was started 1 hour before surgery. Bilateral internal thoracic arteries were harvested and all anastomoses were performed with the off-pump technique via standard median sternotomy. Circumflex branches were anastomosed with the left internal thoracic artery via a heart positioner. RESULTS: All patients remained awake throughout the whole procedure. There was no perioperative myocardial infarction or mortality. Pneumothorax was observed in only 1 patient and did not hinder the procedure. There were no hemodynamic changes during lateral wall revascularization. Two patients required unexpected coronary endarterectomy during circumflex and right coronary artery anastomoses. CONCLUSIONS: Complete arterial revascularization via median sternotomy using in situ bilateral internal thoracic artery grafts without general anesthesia is a feasible and safe procedure for multivessel disease. This approach allows for complete coronary artery revascularization in patients with contraindications for general anesthesia with or without cardiopulmonary bypass.

Anastomosis, Surgical↗
PubMed2006

Topical application of bacitracin ointment is associated with decreased risk of mediastinitis after median sternotomy.

BACKGROUND: The diagnosis of mediastinitis after open-heart surgery is infrequent but dreaded as it carries a high morbidity and mortality. The purpose of this study was to investigate the impact that topical antibacterials would have on the postoperative mediastinitis rate. METHODS: Data were collected from 2455 consecutive patients who underwent sternotomy and cardiopulmonary bypass for both valvar and ischemic heart disease. Prior to 1999, patients (n = 1036) underwent surgery with standard perioperative intravenous antibiotics but no application of bacitracin. After 1999, patients (n = 1419) underwent surgery with intravenous antibiotics and application of bacitracin ointment to the sternotomy incision after closure. RESULTS: Cases of mediastinitis occurred in 12 patients (1.2%) not treated with bacitracin, which required re-exploration, sternectomy, and soft tissue closure of the mediastinum. Alternatively, 3 patients (0.2%) in the group treated with bacitracin developed mediastinitis (P < .01). Therefore, the use of topical antibacterials was associated with a 6-fold reduction in the risk of mediastinitis after cardiac surgery. This significant difference in the infection rate was observed even though the percentage of patients with risk factors for mediastinitis was equal to greater than the group not treated with bacitracin. Non-bacitracin versus bacitracin: diabetics, 298 versus 484; emergency operations, 24 versus 50; bilateral internal thoracic grafts, 28 versus 29; and obesity (body mass index >30), 294 versus 396. CONCLUSIONS: The use of topical antibacterials is associated with a decrease in the risk of mediastinitis after cardiac surgery.

Administration, Topical↗
PubMed2002

Development of C-reactive protein and fibronectin levels in coronary surgery patients: a comparison of on-pump, off-pump sternotomy and off-pump left anterior small thoracotomy groups.

In this prospective study, we monitored two laboratory parameters, C-reactive protein (CRP) and fibronectin (FIN) levels, in 30 patients undergoing elective surgery for ischemic heart disease. These patients were divided into three groups according to the surgical procedure used: group A, approach through a median sternotomy with the use of extracorporeal circulation; group B, approach through a median sternotomy without the use of extracorporeal circulation; and group C, approach through a left anterior small thoracotomy (LAST) without the use of extracorporeal circulation. Peak CRP levels were found in all three groups on the second postoperative day, with the mean levels being statistically significantly higher in group C. This group also showed the highest mean CRP levels on the third and fourth postoperative days, with the difference being statistically nonsignificant. These findings can be explained by an enhanced production of cytokines, which in turn trigger CRP synthesis, induced by postoperative pain due to the LAST procedure. No statistically significant correlation between preoperative CRP levels and their postoperative development was found. None of the groups studied showed any statistically significant decrease in FIN plasma levels, either prior to adjustment for hemodilution or after adjustment for hematocrit and serum albumin.

C-Reactive Protein↗
PubMed1998

[Partial median sternotomy in H. A new approach for cardiac surgery].

PURPOSE: To present our results with the minimally invasive thoracotomy (MIT) in patients with valve disease and to describe a new type of thoracotomy. METHODS: Twenty-five patients with valve disease as the major cardiac problem were operated during a five month period. Two types of incisions were used: one in an inverted-T fashion and another in a H fashion. Fourteen patients were submitted to an inverted-T incision and eleven to a H incision. In 24% of the patients reoperation was being performed. RESULTS: The incisions ranged from 7.5 to 11 cm (mean 9.1 cm), mean ICU stay was 31 h and hospital stay 4.8 days. In all but one patient the operation could be adequately in performed through the MIT, in only one patient total sternotomy had to be performed. CONCLUSION: The MIT may have some advantages such as, better aesthetic results, less pain and more sternal stability. These factors may improve early extubation and decrease hospital stay. The H type incision allows an adequate exposition of the most central part of the chest and all heart valves with adequate exposure. This technique led to no complications during reoperations and we believe it to be as safe as the total sternotomy.

Adolescent↗
PubMed1977

The kinky chest tube: a sign of entrapment following median sternotomy.

Entrapment of chest tubes under one or more sternal sutures is an uncommon complication of median sternotomy. Five cases occurred among 759 median sternotomies performed during a 2 year period. A radiographic sign of chest tube entrapment is presented. Early recognition may prevent a second surgical procedure.

Humans↗
PubMed1983

Complications of median sternotomy: computed tomographic evaluation.

Complications of median sternotomy are infrequent (0.5%-5%) but have a very high mortality and morbidity. Conventional radiographic techniques are of limited value in assessing these complications. Twenty sternotomy patients without problems and 12 with clinical problems were studied with CT. In the control group, focal edema, focal hematomas, and minor sternal irregularities were universal. In the problem group, CT was able to distinguish the six patients without significant infection from the six with major infections. In the latter group, CT was of great value in determining whether the infection was limited to the presternal tissues, the anterior mediastinum, or both.

Abscess↗
PubMed1983

Postoperative median sternotomy dehiscence.

An analysis of the records of 2130 patients who consecutively underwent median sternotomy with or without cardiopulmonary bypass showed that sternal insufficiency necessitating refixation of the sternal plates developed in 12 patients (0.56%). This complication arose during the initial hospital stay in 11 patients, but in one patient the sternal instability appeared about a year after the operation. Re-exploration showed interruption of the stainless steel wires in six cases. In the other cases the wires had loosened, or knots had opened, or wires had cut through the sternal bone. All 12 patients had undergone open-heart surgery. The commonest risk factors for sternotomy dehiscence were excessive blood loss with heavy transfusion requirements, and postoperative wound infections. Other factors were respiratory complications and postoperative ventilatory support, low cardiac output syndrome, chronic obstructive pulmonary disease and obesity. Careful closure of the sternum, using figure-of-eight sutures if necessary, and avoidance of excessive application of bone wax are important for preventing this harmful complication.

Aged↗
PubMed2002

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy.

OBJECT: Exposure of the lower cervical and upper thoracic spinal regions through a cervical incision without sternotomy has been described in cases of anterior decompression and methylmethacrylate vertebral body reconstruction. The use of anterior instrumentation and structural bone grafts in this procedure has not been well described. METHODS: Twenty-one patients underwent anterior cervicothoracic decompression, fusion, and fixation via a low cervical approach. Eight of these patients underwent lower cervical or upper thoracic corpectomy (C7-T4) through the cervical incision. The decompressive procedure was followed by placement of an allograft bone strut and an anterior locking plate system. No patient developed new neurological deficit related to the spinal cord or exiting nerve roots. Three of four patients with preoperative neurological deficits improved dramatically. Two patients developed recurrent laryngeal nerve palsy, of which one was permanent. There was one case of instrumentation-related failure, and two patients developed a superficial wound infection related to a posterior incision made as part of a 360 degrees fusion. Patients were followed for a mean of 18.5 months (range 2-30 months). Two patients died (of metastatic cancer, and a motor vehicle accident, respectively) during the follow-up period. CONCLUSIONS: Anterior decompression, fusion, and fixation is feasible via a cervical incision. This procedural approach spares the patient the morbidity associated with sternotomy or the lateral extracavitary approach. A thorough preoperative assessment of mediastinal anatomy is essential for the safe execution of these procedures.

Aged↗
PubMed1998

[Partial median sternotomy for pediatric cardiac surgery].

In order to minimize scarring and thereby improve the postoperative cosmetic appearance of pediatric cardiac surgery patients, we perform partial median sternotomy incisions. A short midline skin incision, from 1 to 2 cm below the articular notch of the second rib to the xiphoid process, is made. The sternum was divided from the xiphoid process to the articular notch of the second rib. The thymus is mobilized and the pericardium incised longitudinally. The aorta and superior and inferior vena cava are mobilized to facilitate direct cannulation. Cardiopulmonary bypass is instituted in the usual fashion. Twenty-four pediatric patients underwent repair of cardiac anomalies through a partial median sternotomy incision at our institution between June 1997 and September 1998. The average age of the patients was 4 years and 4 months (range, 4 days to 12 years) and the average weight was 16.0 kg (range, 3.2 to 40.5 kg). Cases included 13 VSD (ventricular septal defect) [including one DCRV (double chambered right ventricle) and one PS (pulmonary stenosis)], 9 ASD (atrial septal defect), one ECD (endocardial cushion defect), and one DORV (double outlet right ventricle) with mitral atresia. All patients were extubated within 3 hours after surgery and the average length of the ICU stay was within 24 hours (except for one 4-day-old baby who died of LOS (low cardiac output syndrome) on the 16th postoperative day). There were no wound infections or hospital mortalities. In our experience, this approach is safe, provides good exposure, and provides excellent cosmetic results.

Cardiac Surgical Procedures↗
PubMed1996

Wound infection after median sternotomy during the war in Croatia.

From 1990 to 1994 at Clinical Hospital Center, Zagreb, 1904 median sternotomies were performed for cardiac operations. Patients shared the same intensive care unit (ICU) with the wounded persons, admitted to the hospital from battlefield. Infection developed in 124 patients, an incidence of 6.51%. Methicillin resistant Staphylococcus aureus (MRSA) was isolated from 90, methicillin resistant Staphylococcus epidermidis (MRSE) from 19, and gram negative bacilli (GNB) from 56 patients, Pseudomonas aeruginosa in 2, and Clostridium pneumoniae in 1 case. Ninety-six patients (5.04%) developed superficial localized infection of subcutaneous tissues and they were treated with frequent dressing changes with antibiotic-soaked gauze in combination with systemic antibiotics. Twenty-eight patients (1.47%) developed mediastinitis and sternal dehiscence. They were treated by operative debridement followed by reclosure of the sternum with continuous antibiotic irrigation. We obtained satisfactory results with our method of closure of sternum which is a modification of Robicsek's technique. Nine of them required further operation. In seven cases we performed muscle flaps and in two omentoplasty. One hundred and twenty patients were discharged in satisfactory condition. The uncontrolled mediastinal sepsis caused death in 4 patients. Higher infection rate after median sternotomy during 1991 and 1992 could be possibly explained with the war circumstances in Croatia, and especially with MRSA strain becoming endemic in surgical ICU.

Anti-Bacterial Agents↗
PubMed1979

Pseudomonas sternotomy wound infection and sternal osteomyelitis. Complications after open heart surgery.

Pseudomonas aeruginosa sternotomy wound infections occurred in five patients who underwent open heart surgery. The initial isolate in each case was from a mediastinal chest tube routinely cultured on removal. Soft-tissue infection developed in two patients, and sternal osteomyelitis developed in three patients. Pseudomonas-typing studies showed a correlation between five isolates from chest-tube suction pumps used postoperatively and the wound isolates. Analysis of antibiograms of Pseudomonas wound isolates from the cardiac surgery ward from 1975 to 1977 showed eight of 15 with the same antibiogram as the sternotomy pathogens, compared with two of 13 isolates from other wards.

Cardiac Surgical Procedures↗
PubMed1999

Monofilament absorbable sutures in median sternotomy.

BACKGROUND: The most common material used for closure of median sternotomy incision is steel suture in open heart surgery. Some complications and disadvantages have been investigated recently. These complications are the breaking down of steel suture, erosion of sternum tabulae especially in osteoporotic patients, erosion of the dermis especially in patients with thin subdermic layer and cause of infection. Another disadventage of steel suture material is cosmetic problems or discomfort. For these reasons some suture materials such as silk, polyfilament polyester, monofilament material, polypropylene have been used recently. Silk and polyester have a risk of high infection, and polypropylene causes granulation tissue according to the number of knots. These facts encouraged the usage of an absorbable suture material. The available polyfilament absorbable sutures in the market a few years ago had a short absorption time, causing sternal infection and dehiscence. Polydiaxone, a monofilament suture material introduced recently has a considerably longer absorption time. METHODS: 153 sternal closures were performed with monofilament absorbable suture material in a period of seven months at the Koşuyolu Heart and Research Hospital. The mean age of the patients was 32.55, ranging from 8/12 to 71 years. The mean body weight is 48.37, ranging between 7 kg and 75 kg. RESULTS: Only two patients had sternal dehiscence. CONCLUSIONS: We conclude that monofilament absorbable suture is a safe alternative for all kinds of steel suture material for closure of sternotomy.

Adolescent↗
PubMed1999

[Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy].

We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. Transesophageal echocardiography was used to measure the diameter and the length of descending aorta and the graft. And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.

Aortic Dissection↗
PubMed1999

Pulmonary function following aortic valve replacement: a comparison between ministernotomy and median sternotomy.

BACKGROUND AND AIM OF THE STUDY: Minimally invasive aortic valve replacement (AVR) has several theoretical advantages over standard median sternotomy, but the effects of these techniques on postoperative pulmonary function have not been determined. METHODS: Twenty-six patients undergoing AVR through either a ministernotomy (group M; n = 12) or a median sternotomy (group S; n = 14) underwent pulmonary function tests. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), PaO2 and PaCO2 were determined preoperatively and before hospital discharge (at a mean of five days). Data regarding time to extubation, degree of pain and opening of the pleura were collected prospectively. Both groups had similar preoperative characteristics. RESULTS: There was a significant decrease in FVC, FEVJ, PaO2 and PaCO2 during the postoperative period in all patients, though differences between the groups were not significant. Patients in group M referred less pain than those in group S. In this group, the fall in FVC and FEV1 correlated with the degree of pain, while preoperative FVC correlated with early extubation. Pleurotomy did not affect pulmonary function or pain. CONCLUSION: FVC, FEV1, PaO2 and PaCO2 are reduced significantly following AVR, but a minimally invasive approach does not prevent postoperative pulmonary dysfunction.

Aged↗
PubMed2000

[Respiratory function after coronary artery bypass grafting through mini-sternotomy as a factor of early recovery].

OBJECTIVES: Early recovery in patients after minimally invasive coronary artery bypass grafting with mini-sternotomy and cardiopulmonary bypass (MICS-CABG) was compared to standard CABG by assessing preoperative and postoperative (7 to 10 days after) respiratory function. METHODS: Fifteen patients (Group M; mean age 62.1 years) underwent MICS-CABG with a mean of 2.3 distal anastomoses per patient. Ten patients (Group F; mean age 63.8 years) underwent standard CABG through full sternotomy with a mean of 2.4 distal anastomoses per patient. RESULTS: Postoperative coronary angiography showed that the patency rate of the grafts was 97% in Group M and 96% in Group F. Intubation time and hospital stay were significantly shorter (p < 0.01) in Group M (6.2 +/- 2.4 hours, 16.3 +/- 3.1 days) than in Group F (10.8 +/- 2.9 hours, 22.8 +/- 2.5 days). Respiratory function measured as the percentage of postoperative to preoperative values (Group M/Group F; mean +/- standard error) were vital capacity of 95.8 +/- 3.1%/74.6 +/- 3.4% (p < 0.05), 1 sec percentage of forced expiratory volume of 98.8 +/- 2.3%/71.8 +/- 2.8% (p < 0.05) and peak expiratory flow rate of 91.7 +/- 4.2%/89.4 +/- 4.5%. CONCLUSIONS: Quick recovery of the respiratory function after MICS-CABG may be important in the early recovery and short hospital stay of MICS-CABG patients compared with standard CABG patients.

Aged↗
PubMed2000

[The application of poly (L-lactide) sternal coaptation pins for median sternotomy].

Poly (L-lactide) sternal coaptation pin has been developed as an assistant material for the fixation of sternum. We used the novel material to a patient who underwent median sternotomy. A 21-year-old male was suspected to have invasive thymoma in the anterior mediastinum. The median sternotomy was indicated as an approach for the resection of tumor. Tumor was completely resected and there was no invasion to sternum. For the fixation of sternum, three poly (L-lactide) sternal coaptation pins were inserted in the bone marrow of sternum and five stainless steel wires were used as conventional procedure. Sternum was adapted without slippage and no complication from the material was observed in the post-surgical period. The application of poly (L-lactide) sternal coaptation pin is a good option for ensuring the fixation of sternum.

Adult↗
PubMed2000

[Limited upper sternotomy for minimally invasive aortic valve replacement].

The practice of minimally invasive valve surgery remains controversial. From May 1998, we began minimal invasive aortic valve replacement through the limited upper sternotomy. This technique is simple and provides and easy approach for the aortic valve. From May 1998 to Jan 2000, we performed 15 cases of aortic valve replacement with the limited upper sternotomy approach. All patients received valve replacement with prosthetic valve. We also described a simple and easy air evacuation system to avoid air embolism, a serious problem with a limited operative field. Mean aortic cross clamping time was 79 min, mean cardiopulmonary bypass time was 106 min, and mean operation time was 207 min. It did not take too much time compared with the conventional approach. Mean extubation time was 62 min and mean bleeding 12 hours after the operation was 96 ml. No patient required blood transfusions. All patients but one walked the very next day after the operation. We believe this new method brings not only cosmetic benefits, but also results in excellent post-operative course.

Adult↗
PubMed2000

Aortic valve replacement via minimal-access complete sternotomy.

Minimally invasive approaches to the chest for aortic valve replacement have been proposed recently in an attempt to reduce postoperative pain, length of hospital stay, and scarring. An alternative approach entailing a minimal skin incision and a complete median sternotomy is presented herein. This technique combines the advantage of limited cosmetic impact with the pattern of postoperative pain and the ventilatory mechanics typical of the sternotomy, which enables extubation upon skin closure and early discharge from the hospital.

Aortic Valve↗