초록접수 현황
| 15F-184 | 구연 발표 |
Clinical Impact of Lower Partial Sternotomy for Cardiac Surgery
김종헌, 김태윤, 차병기, 송준영, 김경화, 최종범, 구자홍
전북대학교 의학전문대학원 전북대학교병원 흉부외과학교실
Background : Full median sternotomy is one of the risk factors associated with intraoperative brachial plexus injury or peripheral nerve injury with an estimated incidence of 2%–38%. Caudal localization of the retractor is useful to prevent the injuries, but it cannot always preserve the shoulder girdle from the lateral traction. Lower partial sternotomy that preserves the upper part of the manubrium seems to prevent unwanted traction of the shoulder girdle. The purpose of this study is to evaluate the clinical benefits of the lower partial sternotomy for cardiac surgery.
Methods : From January, 2015 to August, 2015, 12 patients underwent cardiac surgery via lower partial sternotomy. For the partial sternotomy, CABG was excluded. The sternum was divided vertically in the midline from the first intercostal space to the xipho-sternal junction, preserving the upper half of the manubrium and reducing the skin incision length.
Results : Mean age of 12 patients who underwent cardiac surgery via lower partial sternotomy was 65.6 ± 11.8 years and seven patients (58.3%) were female. During operation, there was no conversion to full sternotomy. Eight patients received aortic valve replacement, three patients mitral valve replacement, and the other three patients mitral valve repair. Of them, one patient had concomitant tricuspid valve repair, two patients graft replacement for ascending aortic aneurysm, and one patient excision of left atrial myxoma. Direct cannulation in the ascending aorta and two vena cava cannulation were always possible. Nobody complained of pain of the shoulder girdle or tingling sensation of forearms and hands. All patients can do early works using upper extremities like car drive. There was no sternal infection or instabilities. After discharge, only two patients required NSAIDs for pain control for 2 weeks or more because of excessive lateral traction of his hard sternal wall during operation.
Conclusion : Lower partial sternotomy provided an adequate exposure of operative field during most cardiac operations except for coronary bypass surgery. It seems to be a useful approach for cardiac surgery to prevent traction injury to brachial plexus, to reduce the sternal pain, and to start works early using the upper extremities, especially in aged patients with relatively friable sternum.
Methods : From January, 2015 to August, 2015, 12 patients underwent cardiac surgery via lower partial sternotomy. For the partial sternotomy, CABG was excluded. The sternum was divided vertically in the midline from the first intercostal space to the xipho-sternal junction, preserving the upper half of the manubrium and reducing the skin incision length.
Results : Mean age of 12 patients who underwent cardiac surgery via lower partial sternotomy was 65.6 ± 11.8 years and seven patients (58.3%) were female. During operation, there was no conversion to full sternotomy. Eight patients received aortic valve replacement, three patients mitral valve replacement, and the other three patients mitral valve repair. Of them, one patient had concomitant tricuspid valve repair, two patients graft replacement for ascending aortic aneurysm, and one patient excision of left atrial myxoma. Direct cannulation in the ascending aorta and two vena cava cannulation were always possible. Nobody complained of pain of the shoulder girdle or tingling sensation of forearms and hands. All patients can do early works using upper extremities like car drive. There was no sternal infection or instabilities. After discharge, only two patients required NSAIDs for pain control for 2 weeks or more because of excessive lateral traction of his hard sternal wall during operation.
Conclusion : Lower partial sternotomy provided an adequate exposure of operative field during most cardiac operations except for coronary bypass surgery. It seems to be a useful approach for cardiac surgery to prevent traction injury to brachial plexus, to reduce the sternal pain, and to start works early using the upper extremities, especially in aged patients with relatively friable sternum.
책임저자: 최종범
전북대학교 의학전문대학원 전북대학교병원 흉부외과학교실
연락처 : 김종헌, Tel: 063-250-1480 , E-mail : kim77jh@gmail.com
