| Identifying patients at particular risk of injury during repeat sternotomy: analysis of 2555 cardiac reoperations. | |
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MedLine Citation:
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PMID: 20951254 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Chan B Park; Rakesh M Suri; Harold M Burkhart; Kevin L Greason; Joseph A Dearani; Hartzell V Schaff; Thoralf M Sundt |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-18 Completed Date: 2010-11-08 Revised Date: 2011-05-03 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1028-35 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiopulmonary Bypass / adverse effects Chi-Square Distribution Coronary Artery Bypass / adverse effects*, mortality Female Heart Valve Prosthesis Implantation / adverse effects*, mortality Hospital Mortality Humans Logistic Models Male Middle Aged Minnesota Odds Ratio Postoperative Complications / etiology*, mortality, prevention & control Radiotherapy / adverse effects Reoperation Retrospective Studies Risk Assessment Risk Factors Sternotomy / adverse effects*, mortality Treatment Outcome Vascular Patency |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2011 Apr;141(4):1085; author reply 1085
[PMID:
21419908
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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