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At least 343 records · Page 19Linked to original sources
PubMed2001

[Inferior mini-sternotomy for off-pump CABG using bilateral internal thoracic arteries].

Case 1: A 72-year-old woman with effort angina underwent coronary artery bypass grafting. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. This patient had previously undergone right upper lobectomy due to lung cancer. With a skin incision of 8 cm, the LITA was inserted into the LAD and the RITA was inserted into the mid RCA through an inferior mini-sternotomy while the heart was beating. Case 2: A 69-year-old man with effort angina underwent CABG. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, 75% stenosis in the PDA and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. With a skin incision of 11 cm, the LITA was inserted into the LAD, the RITA into the mid-RCA and the radial artery graft attached to the RITA was grafted to the PDA through an inferior mini-sternotomy while the heart was beating. In both cases, the sternum was not cut transversely in order to prevent injury to the ITAs and pseudo-joint formation. With the use of this technique, exposure of the LAD and RCA was excellent. Postoperative recovery in both patients was uneventful and postoperative angiograms revealed widely patent grafts. This technique was very useful when performing off-pump CABG using bilateral ITAs.

Aged↗
PubMed2001

[Partial sternotomy for off-pump coronary artery bypass grafting].

We performed off-pump coronary artery bypass grafting through a partial sternotomy. The sternum was spit like C-shape configuration from the second intercostal space down to the xiphoid junction. The left internal mammary arteries were mobilized and anastomosed to the left anterior descending arteries. Saphenous veins were grafted between the ascending aorta and the right coronary arteries or diagonal branches. After the surgery, excellent stability of the thorax with minimized incisions enhanced the early recovery. We believe that partial sternotomy approach may be useful in some cases of off-pump CABG.

Aged↗
PubMed2001

Comparison of minithoracotomy with conventional sternotomy methods in valve surgery.

BACKGROUND: To determine the differences in the operative findings between the two groups of patients who had undergone either minithoracotomy or conventional sternotomy. METHODS: We compared 12 valve operations that were performed in our clinic with minithoracotomy (group I) between January 1997 and November 1999 with 13 valve operations that were performed with conventional median sternotomy (group II) in the same period in regard to preoperative, perioperative and postoperative variables, retrospectively. Preoperative variables were age, sex, bleeding time, clotting time, platelet count, and additional diseases like diabetes mellitus, hypertension, etc. Perioperative variables were extracorporeal circulation (ECC) time, cross-clamp (CC) time, and operation time. Postoperative variables were mechanical ventilation period, stay in the postoperative intensive care unit and hospital, mediastinal drainage amount, the amount of blood and blood products for transfusions, and costs. Group I consist of six mitral valve replacements (MVRs), three aortic valve replacements (AVRs), one aortic valve replacement combined with mitral valvuloplasty, and two tricuspid valve replacements (TVRs). Group II consist of nine MVRs and four AVRs. RESULTS: Statistical results are given with mean standard error (SEM) deviations. There were significant differences between the two groups in respect to operation time (in group I, mean operation time was 328 +/- SEM 22 minutes in group II, 271 +/- SEM 14 minutes (p < 0.04)); mediastinal drainage (in group I, mean drainage time was 283 +/- SEM 57 cc/m2, in group II, 490 +/- SEM 74 cc/m2 (p < 0.04)); and amounts of transfused blood and blood products (in group I, mean transfused blood products amount was 375 +/- SEM 115 cc/m2, in group II, 874 +/- SEM 184 cc/m2 (p < 0.03)). CONCLUSION: The operation times are apparently longer in the minithoracotomy group. On the other hand, less mediastinal drainage occurred and less blood and blood products transfusion needs were determined to exist in the minithoracotomy group.

Adult↗
PubMedDate not supplied

An approach to intrapericardial inferior vena cava through the abdominal cavity, without median sternotomy, for total hepatic vascular exclusion.

In surgical resection for hepatocellular carcinoma with tumor thrombus extending into the inferior vena cava and other malignancies involving the retrohepatic inferior vena cava, the usefulness of total hepatic vascular exclusion has been reported by several authors. Total hepatic vascular exclusion usually consists of clamping at three points; at the infrahepatic inferior vena cava, at the suprahepatic inferior vena cava, and in Pringles' maneuver. Tumor thrombus extending into the inferior vena cava at the intrapericardial level below the right atrium can be resected without the use of cardio-pulmonary bypass. The inferior vena cava at the intrapericardial level has been reported to be usually approached by median sternotomy such as Chevron incision. We herein demonstrate an approach to the intrapericardial inferior vena cava through the abdominal cavity without median sternotomy.

Aged↗
PubMed2002

[Reconstruction of cervical esophageal anastomosis using median sternotomy].

We performed cervical oesophageal anastomosis in 153 patients in 10 years. In 11 patients reconstruction or delayed anastomosis was performed through median sternotomy because cervical approach was not suitable. Reoperations were the following: 7 oesophageal stenosis which couldn't be dilated, 2 necrosis of the transplanted organ and 2 because of delayed anastomosis. 8 patients had oesophageal tumors and 3 erosive fluid reflux. During median sternotomy the transplanted organ was injured twice. In 9 patients after reconstruction dysphagia disappeared, in one pharyngo-ileostomy stenosis was noticed and one of the patients died because of ARDS after a leak.

Adult↗
PubMed2003

[Aortic valve repair with minimal access "J" sternotomy].

Recently many cardiovascular operations have been performed with minimally invasive cardiac surgery (MICS). It is reported that MICS is superior to standard full sternotomy in regard to cosmetic and post-operative recovery. In our institution, aortic valve repair operations have been performed to aortic valve insufficiency. This time, we performed aortic valve repair by minimal access "J" sternotomy. A 63-year-old male with degenerative aortic regurgitation underwent aortic valve repair by MICS. He had experienced dyspnea on exertion 7 days before admission. Preoperative transthoracic echocardiogram showed the grade of aortic regurgitation (AR) was severe. Surgery was successful and the grade of AR became trivial. This combined procedure have merits for patients because of freedom from anticoagulation and small incision. Such combined surgery may be indicated in the treatment in a subset of patients with degenerative AR.

Aortic Valve↗
PubMed1992

Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.

Over a 5-year period from 1985 to 1989, 2760 patients underwent open heart surgery at the University Hospital of Wales. Of these, 44 (1.6%, 35 men, mean age 61 years) developed median sternotomy dehiscence 2-40 (median 9) days after surgery. Infection was an associated factor in 18 patients (41%) and Staphylococcus aureus the predominant isolate in seven of those. Thirty-seven patients underwent rewiring of the sternotomy wound and seven patients underwent debridement, removal of wires and delayed closure. In those undergoing rewiring, sternal stability was maintained in 34 patients (92%). There were seven deaths (16%), of which two were considered to be wound-related. Median hospital stay of survivors was 34 (range 16-84) days. Comparison with 88 matched controls by univariate analysis showed preoperative chronic obstructive airways disease, reduced FEV1/FVC ratio (both P < 0.001) and smoking (P < 0.05) were all more common in the dehiscence group. In addition, reoperation for bleeding (P < 0.05), prolonged bypass time, postoperative ventilation period and length of stay in the intensive care unit (all P < 0.001) were more common in the study group.

Cardiac Surgical Procedures↗
PubMed1976

REPEAT STERNOTOMY: AN IMPROVED SURGICAL TECHNIQUE.

An improved method of opening the sternum for intracardiac or extracardiac procedures following one or more previous midline sternotomies is described. In our institution, the Stryker(R) pneumatically-driven(*) Sagittal Saw with right-angled blade is used. During the past two years, approximately 75 repeat sternotomies have been performed, and in no instance has a cardiac chamber or great vessel been injured.

Journal Article↗
PubMed1989

Management of the complicated sternotomy incision: results of omentopexy with primary skin graft.

Non-healing mid-sternotomy wounds are a persistently difficult problem. The numerous methods that have been employed to manage these wounds are costly in terms of patient discomfort and length of hospital stay. We present a method to manage a complicated sternotomy that uses an omental flap with an immediate, split-thickness skin graft. This technique promotes rapid healing and minimizes length of hospital stay.

Journal Article↗
PubMedDate not supplied

[Imaging of median sternotomy complications].

Median sternotomy is the surgical technique of chosen for cardiac surgery. Although the complications after median sternotomy are not so frequent, these are associated to elevated mortality. The complications can interest the presternal compartment, the sternal compartment or the retrosternal compartment. Even if the clinical diagnosis of infection is not difficult for the clinician, it is nearly impossible to establish the depth of the infection. Multislice CT, thanks to the possibility to obtain thin layers and three-dimensional multiplanar reconstructions and Volume Rendering, turns out extremely useful for being able to demonstrate the extension and the depth of the infection. Of fundamental importance it is the elaboration of the images, executed on workstation, with which multiplanar reformatted and Volume Rendering images are obtained. The CT turns out useful moreover like guide for the execution of interventional procedures such as aspiration of material for bacteriological characterization or eventual positioning of a catheter for abscess drainage. The Magnetic Resonance, thanks to its high resolution of contrast and to its multiplanarity, finds one of its elective applications in the study of the flogistic and neoplastic processes of the soft tissues. A great limit of the MR is the possible generation of artifacts due to sternal suture.

Cardiac Surgical Procedures↗
PubMed1992

[Closure of median sternotomy incision with EPTFE sutures].

EPTFE (CV-0) suture was utilized for closure of median sternotomy incision in 100 patients under 6 years of age who underwent open heart surgery. During 3 years follow up, except for one dislocation of sternum, all patients have healed without complication. EPTFE suture is swanged to a needle that has the same diameter as the thread, which reduces bleeding from the needle hole. It is radiologically lucent, and therefore does not disrupt chest X-ray, angiography or MRI investigations, in contrast to sternal wires. In addition, in the case of life threatening postoperative complication, EPTFE suture allows rapid and simple access to the heart, without the need to cut wires. We concluded that EPTFE suture can be utilized for closure of median sternotomy in patients under the age of six, without an increased risk of postoperative or long-term complications.

Child, Preschool↗
PubMed1991

[Poly-lactic-acid (PLA) sternal pins for the closure of median sternotomy--report of a case].

Poly-lactic-acid (PLA) sternal pins were used for the closure of median sternotomy in a case of bilateral pneumothorax. After placement 7 sutures of polyester and 2 wires, PLA sternal pins were inserted into the bone marrow of the sternum. The wires were then twisted and tightened, and all sutures were tightened, and the wires were removed. No significant postoperative complications, i.e., osteomyelitis and mediastinitis, sternal dehiscence, or bone marrow dysfunction, were observed. In addition, the PLA sternal pins were absorbed. In the closure of median sternotomy, PLA sternal pins provide stable sternal adhesion, which is essential to the prevention of sternal dehiscence and other complications. Moreover, with the use of PLA sternal pins, the retention of steel wires in the body is unnecessary.

Adolescent↗
PubMedDate not supplied

Giant emphysematous bullae: surgical treatment using the median sternotomy approach.

Seven patients were operated for simultaneous excision of giant emphysematous bullae through a median sternotomy. They were all symptomatic and with a history of alcohol and/or drug abuse. Preoperative evaluation included bilateral chest tomograms and complete pulmonary function test. Surgical technique included bilateral resection of giant bullae and pleurodesis with minimal postoperative morbidity and no mortality. No correlation was found between symptomatic clinical improvement and measured postoperative pulmonary function. The median sternotomy approach is indeed the method of choice for bilateral giant emphysematous bullae.

Adult↗
PubMed1991

Pulmonary metastasectomy by median sternotomy.

The results of pulmonary metastasectomy by a median sternotomy approach were retrospectively studied in 38 patients. This approach enabled the exploration of both thoracic cavities and, subsequently, the detection of other metastases. Such occult metastases were present in 11 of the 38 patients, four patients had unsuspected metastases at the contralateral side. There was no postoperative mortality, the morbidity associated with the median sternotomy and bilateral exploration was low. Pneumothorax occurred in three patients, pulmonary infection in four patients and a superficial wound infection in one patient. Hospital stay ranged from 4-25 days (mean 10 days). The five-year actuarial survival rate was 15 per cent. Resectability did not correlate significantly with long-term survival, neither did primary histology, disease-free interval or the presence of bilateral disease. The number of metastases was a highly significant predictor of survival (p = 0.0004).

Adult↗
PubMed1991

[A young female case with simultaneous bilateral spontaneous pneumothorax operated upon submammarian incision for median sternotomy].

One of the characteristics of pneumothorax in female is considerably complicated with menses, histiocytosis X, diffuse pulmonary hamartoangiomyomatosis. So during thoracotomy, the thoracic cavity must be examined, as well as the hole of the diaphragm. And especially in female aesthetic attention is also required. A transverse submammarian skin incision with median sternotomy was used in a 18-year-old female with simultaneous bilateral pneumothorax. This approach was useful for the median sternotomy as well as more excellent aesthetics.

Adolescent↗
PubMed1990

[Suppurative complications following sternotomy].

For a ten-year period when 366 median sternotomies have been performed, 206 of them in cardiac operations under bypass, there were 15 dehiscences of the sternum (4.09 per cent). The method of early revision with subsequent one-story suture and persistently washing aspiration drainage was applied for treatment of grave complication. In 90 per cent of the patients the causative agent of the infection was Pseudomonas aeruginosa and in the rest--Staph.aureus. Despite the early intervention, the adequate antibacterial therapy and local application of antiseptic agents, mortality was 46.6 per cent. The authors introduced also the so called nodulating sternotomy, which provides firmer fixation. This operation was performed in 135 patients. Rigid septics and antiseptics play crucial role for nonadmission of infection in operations under bypass.

Adult↗
PubMedDate not supplied

Submammary median sternotomy.

A vertical skin incision is used as routine approach for sternotomy. The resulting scar is often disappointing and the top is visible and unpleasant, especially for young women. In 35 women ranging from 10 to 48 years (mean 29.2 years), median sternotomy was performed via a submammary skin incision. In all cases an open heart surgical procedure was performed. Adequate exposure of the heart was achieved in every case and there were no technical problems related to this approach, no hospital mortality or major complications. The cosmetic result is excellent and this approach is certainly justified in open heart surgery for young women.

Adult↗
PubMed1989

[Simplified technique for closure of median sternotomy incision: the use of bone stapler].

A new technique with the bone stapler (Staplizer) was applied in 11 patients undergoing open-heart surgery for closure of a median sternotomy incision. The staplers were used for fixation of the sternum following partial trans-sternal fixation with two wires. The method was quick and easy to perform, and effective in establishing firm and permanent approximation of the sternum. There were no instances of dehiscence among all the patients with stapler closure. We therefore recommend this technique in median sternotomy closure except for patients with the osteoporotic or elastic sternum.

Adolescent↗