Conversion to full sternotomy during minimal-access cardiac surgery: Reasons and results during a 9.5-year experience

Minoru Tabata, Ramanan Umakanthan, Zain I Khalpey, Sary F. Aranki, Gregory S. Couper, Lawrence H. Cohn, Prem S. Shekar

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective: A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. Methods: Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. Results: Twenty-four (2.6%) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3%) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7% (15/883). Twenty-one (4.0%) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2% (6/507). Conclusion: Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.

Original languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume134
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

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Sternotomy
Thoracic Surgery
Mortality
Cardiac Arrhythmias
Hemorrhage
Ventricular Dysfunction
Postoperative Pain
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Conversion to full sternotomy during minimal-access cardiac surgery : Reasons and results during a 9.5-year experience. / Tabata, Minoru; Umakanthan, Ramanan; Khalpey, Zain I; Aranki, Sary F.; Couper, Gregory S.; Cohn, Lawrence H.; Shekar, Prem S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 134, No. 1, 07.2007, p. 165-169.

Research output: Contribution to journalArticle

Tabata, Minoru ; Umakanthan, Ramanan ; Khalpey, Zain I ; Aranki, Sary F. ; Couper, Gregory S. ; Cohn, Lawrence H. ; Shekar, Prem S. / Conversion to full sternotomy during minimal-access cardiac surgery : Reasons and results during a 9.5-year experience. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 134, No. 1. pp. 165-169.
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abstract = "Objective: A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. Methods: Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. Results: Twenty-four (2.6{\%}) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3{\%}) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7{\%} (15/883). Twenty-one (4.0{\%}) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2{\%} (6/507). Conclusion: Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.",
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AU - Umakanthan, Ramanan

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AU - Aranki, Sary F.

AU - Couper, Gregory S.

AU - Cohn, Lawrence H.

AU - Shekar, Prem S.

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N2 - Objective: A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. Methods: Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. Results: Twenty-four (2.6%) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3%) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7% (15/883). Twenty-one (4.0%) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2% (6/507). Conclusion: Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.

AB - Objective: A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. Methods: Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. Results: Twenty-four (2.6%) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3%) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7% (15/883). Twenty-one (4.0%) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2% (6/507). Conclusion: Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.

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