Elahi Maqsood, Dhannapuneni Ramanarao, Firmin Richard, Hickey Mark
Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, United Kingdom.
Asian Cardiovasc Thorac Ann. 2005 Jun;13(2):135-8. doi: 10.1177/021849230501300208.
Whilst the potential risk to underlying vital structures from redo-sternotomy is well recognized, the actual risk is poorly quantified. Our aim was to determine the incidence of complications directly attributable to redo-sternotomy and to ascertain whether the use of femoro-femoral CPB (FF) prior to redo-sternotomy alters operative morbidity and mortality. Case notes of 185 patients undergoing cardiac surgery necessitating redo-sternotomy between May 1998 and November 2002 were reviewed. Of 121 males and 64 females, the median age was 65.5 years (range 60.1-75 years). Elective FF was performed in 71 (38.3%) of cases and 114 (60%) were performed without the aid of prior femoro-femoral CPB (WFF). Three (1.6%) patients initially planned for WFF were converted to emergency FF due to serious complications. Complications directly attributable to redo-sternotomy occurred in 21 (11.3%) cases; 12 (16.9%) in the FF group and 9 (5.3%) in the WFF group. Overall mortality was 1.6%. In summary, our results suggest that morbidity risk for the operation increases significantly with redo-sternotomy alone. Three deaths in our series from direct complications attributable to redo-sternotomy signify an added risk. Hence the necessity for careful surgical technique and judicious use of elective FF-CPB is emphasized.
虽然再次开胸手术对重要基础结构的潜在风险已得到充分认识，但实际风险却难以量化。我们的目的是确定直接归因于再次开胸手术的并发症发生率，并确定在再次开胸手术前使用股-股体外循环（FF）是否会改变手术发病率和死亡率。我们回顾了1998年5月至2002年11月期间185例需要再次开胸手术的心脏手术患者的病历。其中男性121例，女性64例，年龄中位数为65.5岁（范围60.1 - 75岁）。71例（38.3%）患者进行了选择性FF，114例（60%）未采用术前股-股体外循环（WFF）。3例（1.6%）最初计划进行WFF的患者因严重并发症转为急诊FF。直接归因于再次开胸手术的并发症发生在21例（11.3%）；FF组12例（16.9%），WFF组9例（5.3%）。总体死亡率为1.6%。总之，我们的结果表明，仅再次开胸手术的发病率风险会显著增加。我们系列中有3例因再次开胸手术直接并发症导致的死亡表明存在额外风险。因此，强调了谨慎的手术技术和明智使用选择性FF - CPB的必要性。
