Repeat sternotomy in congenital heart surgery: no longer a risk factor

The Annals of Thoracic Surgery
David L S MoralesCharles D Fraser

Abstract

The risk of repeat sternotomy (RS) is often taken into account when making clinical management decisions. Current literature on RS suggests a risk of approximately 5% to 10% for major morbidity. We sought to establish the true risk of RS in a contemporary pediatric series. All RS between October 2002 and August 2006 were analyzed (602 RS in 558 patients). Median age was 3.6 years (range, 0.1 to 45.1); weight, 14.2 kg (2.0 to 112.2). Operations performed at RS were Glenn 22% (131), Fontan 21% (129), aortic valve repair/replacement 12% (72), right ventricle-pulmonary artery conduit 11% (67), Rastelli 7% (39), heart transplant 5% (31), and other 22% (133). Forty-seven percent of patients (280) had single-ventricle physiology. Incidence of second sternotomy was 67% (406), third 28% (166), fourth 4% (24), fifth 0.8% (5), and sixth 0.2% (1). A major injury upon RS was defined as one causing hemodynamic instability requiring vasopressor support or emergent transfusion; femoral cannulation or emergent cardiopulmonary bypass; and any morbidity. A minor injury is any other injury during RS. The incidence of a major injury was not different between RS (0.3%; 2 of 602) and first-time sternotomy (0%; 0 of 1,274; p > 0.1). Incidence of a min...Continue Reading

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Citations

Apr 2, 2013·Interactive Cardiovascular and Thoracic Surgery·Fabrizio GandolfoAdriano Carotti
Apr 8, 2014·The Journal of Thoracic and Cardiovascular Surgery·E Dean McKenzieCharles D Fraser
Dec 3, 2014·Seminars in Thoracic and Cardiovascular Surgery·Daniel J DiBardino, Jeffrey P Jacobs
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Feb 19, 2013·Journal of the American College of Surgeons·E Dean McKenzieCharles D Fraser
Jul 2, 2011·The Annals of Thoracic Surgery·Kimberly A HolstHartzell V Schaff
Sep 22, 2009·The Annals of Thoracic Surgery·Alessandro GiambertiMarco Ranucci
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Dec 15, 2019·World Journal for Pediatric & Congenital Heart Surgery·Bahar TemurErsin Erek
Apr 26, 2019·World Journal for Pediatric & Congenital Heart Surgery·Kyle W RiggsDavid L S Morales
Aug 14, 2019·Journal of Functional Biomaterials·Varinder Pal Singh SidhuMarcello Papini
Jul 11, 2020·World Journal for Pediatric & Congenital Heart Surgery·Siddharth PahwaJoseph A Dearani
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Sep 19, 2020·The Annals of Thoracic Surgery·Kei KobayashiHiroshi Niinami
May 5, 2021·World Journal for Pediatric & Congenital Heart Surgery·Sudesh PrabhuShreesha Maiya

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