This study aimed to assess the main risk factors contributing to postoperative separation of the sternum and to substantiate the recommendations on the optimal number of sternal polyspast and multi-twist knots based on data from international literature and our own experience. In this study, the indicators such as gender, age, height, body weight, body mass index, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, separation during the surgery of the internal thoracic artery, and re-exploration were evaluated. A key indicator was the sutures applied on the sternum after sternotomy, precisely the suture type (polyspast and multi-twist) and number. The study was conducted in the Federal Cardiovascular Surgery Center of the Ministry of Health of Russia (Chelyabinsk). The final sample was 1 051 patients in 2019. The patients were distributed into two groups; those without separation of the sternum in the postoperative period (n= 1 038) and those with sternum separation (n= 13). In the course of this study, we found that the most significant factors were the height and weight of patients. The multivariate analysis of variance showed that for multi-twist sutures, an additional sternal knot was required for every 4 cm of height, starting from 163 cm, and for every 7 kg of body weight, starting from 81 kg. For polyspast sutures, one additional sternal knot was required for every 5 cm of height, starting from 165 cm, as well as for every additional 5 kg of body weight, starting from 76 kg. When planning the number of sternal sutures, the height and weight of the patients body should be taken into account in aggregate, and the number of knots should be formed according to a more significant indicators.
Цель исследования-изучение внутриутробной оперативной коррекции пороков развития сердца. Рассмотрена проблема проведения внутриутробных операций на сердце. На современном этапе развития медицины появилась возможность проводить первый этап коррекции тяжелых врожденных пороков сердца уже во внутриутробном периоде. Эти состояния включают: критический аортальный стеноз и развивающийся синдром гипоплазии левых отделов сердца; атрезию легочной артерии или критический стеноз легочной артерии у плода с интактной межжелудочковой перегородкой и развивающимся синдромом гипоплазии правого желудочка; синдром гипоплазии левых отделов сердца с интактной межпредсердной перегородкой или рестриктивным дефектом межпредсердной перегородки. В этих случаях возможно применение внутриутробной баллонной вальвулопластики и предсердной септостомии. Выполнение данных вмешательств во время беременности может иметь положительное влияние как на дальнейшее развитие сердца плода, так и на результаты последующих оперативных вмешательств. Ключевые слова: врожденные пороки сердца, фетальная хирургия, перинатальная медицина, внутриутробные операции на сердце.
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