Effect of sternotomy direction on the incidence of inadvertent pleurotomy

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.