Identifying patients at particular risk of injury during repeat sternotomy

Analysis of 2555 cardiac reoperations

Chan B. Park, Rakesh M. Suri, Harold M. Burkhart, Kevin L. Greason, Joseph A. Dearani, Hartzell V Schaff, Thoralf M. Sundt

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objectives: A variety of protective strategies during repeat sternotomy been proposed; however, it remains unclear for which patients they are warranted. Methods: We identified adults undergoing repeat median sternotomy for routine cardiac surgery at our institution between January 1, 1996, and December 31, 2007. The operative notes and perioperative outcomes were reviewed. Results: Of the 2555 patients, 1537 (60%) had undergone previous coronary artery bypass grafting, 700 (27%) previous mitral valve surgery, and 643 (25%) previous aortic valve replacement (AVR). Sixty-one patients (2%) had prior mediastinal radiotherapy, and 424 (17%) had more than one previous sternotomy. In 231 patients, 267 injuries (9.0%) occurred. Injury occurred during sternotomy in 87 patients (33%) and during prepump dissection in 135 (51%). The hospital mortality rate was 6.5% among those without injury and 18.5% among those with injury (P < .001); when injury occurred during sternal division, the mortality rate was 25%. Injuries were more common after previous coronary artery bypass grafting (11% with previous coronary artery bypass grafting vs 7% without, P = .0012) but not previous AVR, mitral valve surgery, or aortic surgery. Injury was also more common when the current operation was AVR (10% with AVR vs 8% without, P = .04) or aortic surgery (14% vs 8%, P = .004). On multivariate analysis, previous radiotherapy (odds ratio, 4.9), a greater number of previous sternotomies (odds ratio 1.7), and a patent internal thoracic artery (odds ratio, 1.8) predicted injury. Injury was an independent risk factor of hospital death (odds ratio, 2.6). Conclusions: Particular attention to protective strategies should be considered during reoperative sternotomy among patients with multiple previous sternotomies, previous mediastinal radiotherapy, and those with patent internal thoracic artery grafts.

Original languageEnglish (US)
Pages (from-to)1028-1033
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number5
DOIs
StatePublished - Nov 2010

Fingerprint

Sternotomy
Reoperation
Wounds and Injuries
Aortic Valve
Odds Ratio
Coronary Artery Bypass
Radiotherapy
Mammary Arteries
Mitral Valve
Mortality
Hospital Mortality
Thoracic Surgery
Dissection
Multivariate Analysis
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Identifying patients at particular risk of injury during repeat sternotomy : Analysis of 2555 cardiac reoperations. / Park, Chan B.; Suri, Rakesh M.; Burkhart, Harold M.; Greason, Kevin L.; Dearani, Joseph A.; Schaff, Hartzell V; Sundt, Thoralf M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 5, 11.2010, p. 1028-1033.

Research output: Contribution to journalArticle

Park, Chan B. ; Suri, Rakesh M. ; Burkhart, Harold M. ; Greason, Kevin L. ; Dearani, Joseph A. ; Schaff, Hartzell V ; Sundt, Thoralf M. / Identifying patients at particular risk of injury during repeat sternotomy : Analysis of 2555 cardiac reoperations. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 5. pp. 1028-1033.
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abstract = "Objectives: A variety of protective strategies during repeat sternotomy been proposed; however, it remains unclear for which patients they are warranted. Methods: We identified adults undergoing repeat median sternotomy for routine cardiac surgery at our institution between January 1, 1996, and December 31, 2007. The operative notes and perioperative outcomes were reviewed. Results: Of the 2555 patients, 1537 (60{\%}) had undergone previous coronary artery bypass grafting, 700 (27{\%}) previous mitral valve surgery, and 643 (25{\%}) previous aortic valve replacement (AVR). Sixty-one patients (2{\%}) had prior mediastinal radiotherapy, and 424 (17{\%}) had more than one previous sternotomy. In 231 patients, 267 injuries (9.0{\%}) occurred. Injury occurred during sternotomy in 87 patients (33{\%}) and during prepump dissection in 135 (51{\%}). The hospital mortality rate was 6.5{\%} among those without injury and 18.5{\%} among those with injury (P < .001); when injury occurred during sternal division, the mortality rate was 25{\%}. Injuries were more common after previous coronary artery bypass grafting (11{\%} with previous coronary artery bypass grafting vs 7{\%} without, P = .0012) but not previous AVR, mitral valve surgery, or aortic surgery. Injury was also more common when the current operation was AVR (10{\%} with AVR vs 8{\%} without, P = .04) or aortic surgery (14{\%} vs 8{\%}, P = .004). On multivariate analysis, previous radiotherapy (odds ratio, 4.9), a greater number of previous sternotomies (odds ratio 1.7), and a patent internal thoracic artery (odds ratio, 1.8) predicted injury. Injury was an independent risk factor of hospital death (odds ratio, 2.6). Conclusions: Particular attention to protective strategies should be considered during reoperative sternotomy among patients with multiple previous sternotomies, previous mediastinal radiotherapy, and those with patent internal thoracic artery grafts.",
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AU - Greason, Kevin L.

AU - Dearani, Joseph A.

AU - Schaff, Hartzell V

AU - Sundt, Thoralf M.

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AB - Objectives: A variety of protective strategies during repeat sternotomy been proposed; however, it remains unclear for which patients they are warranted. Methods: We identified adults undergoing repeat median sternotomy for routine cardiac surgery at our institution between January 1, 1996, and December 31, 2007. The operative notes and perioperative outcomes were reviewed. Results: Of the 2555 patients, 1537 (60%) had undergone previous coronary artery bypass grafting, 700 (27%) previous mitral valve surgery, and 643 (25%) previous aortic valve replacement (AVR). Sixty-one patients (2%) had prior mediastinal radiotherapy, and 424 (17%) had more than one previous sternotomy. In 231 patients, 267 injuries (9.0%) occurred. Injury occurred during sternotomy in 87 patients (33%) and during prepump dissection in 135 (51%). The hospital mortality rate was 6.5% among those without injury and 18.5% among those with injury (P < .001); when injury occurred during sternal division, the mortality rate was 25%. Injuries were more common after previous coronary artery bypass grafting (11% with previous coronary artery bypass grafting vs 7% without, P = .0012) but not previous AVR, mitral valve surgery, or aortic surgery. Injury was also more common when the current operation was AVR (10% with AVR vs 8% without, P = .04) or aortic surgery (14% vs 8%, P = .004). On multivariate analysis, previous radiotherapy (odds ratio, 4.9), a greater number of previous sternotomies (odds ratio 1.7), and a patent internal thoracic artery (odds ratio, 1.8) predicted injury. Injury was an independent risk factor of hospital death (odds ratio, 2.6). Conclusions: Particular attention to protective strategies should be considered during reoperative sternotomy among patients with multiple previous sternotomies, previous mediastinal radiotherapy, and those with patent internal thoracic artery grafts.

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