Three or more median sternotomies for patients with valve disease: role of computed tomography

Morishita, Kiyofumi; Kawaharada, Nobuyoshi; Fukada, Jhoji; Yamada, Akira; Tsukamoto, Masaru; Kuwaki, Kenji; Abe, Tomio

doi:10.1016/s0003-4975(02)04821-x

Cited by 38 publications

(14 citation statements)

References 11 publications

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“…The use and benefits of preoperative CT for cardiac reoperations appears to be increasing [5, 6, 8, 12]. Cremer and colleagues demonstrated a 98% safe re-entry rate and low injury rate (2%) in their study of patients undergoing reoperative CABG [6].…”

Section: Discussionmentioning

confidence: 99%

“…Cremer and colleagues demonstrated a 98% safe re-entry rate and low injury rate (2%) in their study of patients undergoing reoperative CABG [6]. Other series have reported on the role of preoperative CT imaging and the development of alternate surgical strategies [5, 6, 12]. In fact, adoption of alternative surgical strategies has been documented to occur in up to 80% of cases, resulting in a significant reduction in the risk of re-entry injuries and mortality [5, 8, 12].…”

Section: Discussionmentioning

confidence: 99%

“…Other series have reported on the role of preoperative CT imaging and the development of alternate surgical strategies [5, 6, 12]. In fact, adoption of alternative surgical strategies has been documented to occur in up to 80% of cases, resulting in a significant reduction in the risk of re-entry injuries and mortality [5, 8, 12]. In one of the largest series, the benefits of establishing cardiopulmonary bypass via peripheral cannulation prior to sternotomy was demonstrated in the setting of dense retrosternal adhesions identified by preoperative CT [13].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery

LaPar

Ailawadi

Irvine

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Preoperative computed tomography (CT) use appears to be increasing among patients undergoing cardiac reoperations. We hypothesized that preoperative CT imaging reduces adverse outcomes and operative mortality for these patients. From July 2002 to February 2009, 373 patients underwent cardiac reoperations. Patients were stratified according to those with preoperative CT imaging (CT, n=140) and to those without preoperative CT imaging (NCT) (NCT, n=233). Preoperative risk, operative features, and postoperative outcomes were evaluated. Operative mortality for all cardiac reoperations was 7.5%. Patient risk factors were similar between CT and NCT groups. Preoperative imaging was more commonly performed for reoperative isolated valve operations (CT=70% vs. NCT=55.8%, P=0.01) but less commonly performed for reoperative isolated coronary artery bypass grafting (CABG) operations (14.3% vs. 22.7%, P=0.05). Postoperative renal failure, prolonged ventilation and operative mortality were similar between groups. Importantly, perioperative stroke occurred only within the NCT group (5.6% vs. 0.0%, P=0.003), and emergent operative status [odds ratio (OR): 6.45, confidence interval (CI): 1.15–36.10, P=0.03] as an independent multivariate predictor of perioperative stroke. Thus, preoperative CT imaging is associated with lower rates of perioperative stroke in patients undergoing cardiac reoperations by optimizing cannulation and aortic clamping strategies. Routine use of preoperative CT should be considered for patients undergoing cardiac operations following prior sternotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery

LaPar

Ailawadi

Irvine

et al. 2011

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Careful, directed preoperative imaging has been advocated by others as a means to reduce the frequency of injury as well as decrease operative risk in such patients. 43 Finally, Luciani et al 44 reported that presternotomy institution of cardiopulmonary bypass results in shorter global operative times because cardiac decompression affords more expeditious dissection. Such protective adjuncts can enable safe repeat sternotomy in most patients.…”

Section: Frailtymentioning

confidence: 99%

Assessing the Risk of Aortic Valve Replacement for Severe Aortic Stenosis in the Transcatheter Valve Era

Greason

Suri

Leon

et al. 2014

Mayo Clinic Proceedings

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Surgical aortic valve replacement had been the only definitive treatment of severe aortic stenosis before the availability of transcatheter valve technology. Historically, many patients with severe aortic stenosis had not been offered surgery, largely related to professional and patient perception regarding the risks of operation relative to anticipated benefits. Such patients have been labeled as "high risk" or "inoperable" with respect to their suitability for surgery. The availability of transcatheter aortic valve replacement affords a new treatment option for patients previously not felt to be optimal candidates for surgical valve replacement and allows for the opportunity to reexamine the methods for assessing operative risk in the context of more than 1 available treatment. Standardized risk assessment can be challenging because of both the imprecision of current risk scoring methods and the variability in ascertaining risk related to operator experience as well as local factors and practice patterns at treating facilities. Operative risk in actuality is not an absolute but represents a spectrum from very low to extreme, and the conventional labels of high risk and inoperable are incomplete with respect to their utility in clinical decision making. Moving forward, the emphasis should be on developing an individual assessment that takes into account procedure risk as well as long-term outcomes evaluated in a multidisciplinary fashion, and incorporating patient preferences and goals in a model of shared decision making.

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“…This results in a deflation of the heart which indirectly reduces risk of injury [7], [8]. Another option is a preoperative computed tomography (CT) which can help to detect possible retrosternal adhesions and their location, and thus improves safety of the procedure [9], [10]. The retrosternal tissue can be visualized with an endoscope, and can then be removed step by step from the sternum.…”

Section: B Sternotomy and Resternotomymentioning

confidence: 99%

Evaluation of a synergistic handheld instrument for resternotomy controlled by an integrated optical sensor

Korff

Jalowy

Mueller

et al. 2011

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Re-Sternotomy is an important part of many interventions in cardiac or thoracic surgery. It is performed close to critical structures such as the ascending aorta or the heart with an inherent high risk of serious damage. In this paper, a system for improving the safety of this surgical procedure is presented. A soft tissue preserving saw is combined with automatic depth regulation. The depth is controlled on the basis of the optical characteristics (visible light) of the tissue aligned to the saw blade, which is analyzed using a color sensor. Detection of the blades' position in the bone during the cutting process is possible through the integration of an optical fiber into the tip of the saw blade. The automatic depth control is realized using a hysteresis controller running on a real time system. To show the feasibility of this approach, the sensor technology was integrated into a prototypal sternal saw and evaluated on artificial bone. As part of the experiments the influence of water for cooling and dust particles from the process on the systems control stability were analyzed. The system performed stable and accurate. Future research will focus on the control algorithm and cadaver trials.

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Three or more median sternotomies for patients with valve disease: role of computed tomography

Cited by 38 publications

References 11 publications

Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery

Preoperative computed tomography is associated with lower risk of perioperative stroke in reoperative cardiac surgery

Assessing the Risk of Aortic Valve Replacement for Severe Aortic Stenosis in the Transcatheter Valve Era

Evaluation of a synergistic handheld instrument for resternotomy controlled by an integrated optical sensor

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