Our Summary

This research paper discusses a method to safely perform repeat heart surgeries in patients who have a high risk of severe bleeding. The issue arises when the heart’s blood vessels stick to the breastbone. In these cases, the standard approach - stopping the circulation and lowering body temperature - might not provide enough time for a safe operation. The researchers used a technique called percutaneous cardioplegic arrest before fully opening up the chest again. This technique helped to reduce the time the body’s circulation was stopped and cooled down. The paper reports on six cases where this approach was successfully used, and all the patients survived their surgeries. Therefore, the researchers concluded that percutaneous cardioplegic arrest is a safer method to repeat heart surgeries in high-risk patients.

FAQs

  1. What are the risks associated with redo sternotomy in patients with arterial cardiac structures adherent to the sternum?
  2. What is the purpose of using percutaneous cardioplegic cardiac arrest during sternal re-entry?
  3. What were the results of the study involving percutaneous cardioplegic cardiac arrest and sternal re-entry?

Doctor’s Tip

A doctor may advise a patient undergoing sternotomy to be aware of the potential risks of catastrophic bleeding, especially in cases where arterial cardiac structures are adherent to the sternum. They may recommend considering the use of percutaneous cardioplegic cardiac arrest before completing sternal re-entry to minimize the risk of prolonged hypothermic circulatory arrest and improve the safety of the procedure. This approach can help ensure a successful outcome for the patient undergoing a repeat sternotomy.

Suitable For

Patients who are typically recommended sternotomy include those who have arterial cardiac structures adherent to the sternum, particularly in cases of redo sternotomy. This includes patients who have undergone multiple previous operations and are at risk for catastrophic bleeding during sternal re-entry. In these cases, percutaneous cardioplegic cardiac arrest may be used to minimize the risk of exsanguination and allow for a safer repeat sternotomy. This technique has been shown to be successful in complex operations and can help avoid the need for prolonged hypothermic circulatory arrest.

Timeline

Before sternotomy:

  1. Patient is evaluated by a healthcare provider and undergoes diagnostic tests to determine the need for surgery.
  2. Patient is informed about the risks and benefits of the procedure.
  3. Patient is prepped for surgery, including anesthesia administration.
  4. Surgical team prepares for the procedure, including setting up equipment and ensuring proper sterilization.
  5. Surgeon makes an incision in the chest and accesses the heart through the sternum.

After sternotomy:

  1. Surgeon performs the necessary cardiac procedures, such as bypass surgery or valve replacement.
  2. Patient is monitored closely during the surgery for any complications.
  3. After the procedure is completed, the sternum is closed with sutures or wires.
  4. Patient is taken to the recovery room for post-operative care and monitoring.
  5. Patient is discharged from the hospital once deemed stable and able to continue recovery at home.
  6. Follow-up appointments are scheduled to monitor the patient’s progress and address any concerns.

What to Ask Your Doctor

  1. What are the risks and complications associated with sternotomy in my specific case, considering my medical history and previous surgeries?
  2. Are there any alternative procedures or techniques that can be used to minimize the risks associated with sternotomy in my case?
  3. How will the decision to use percutaneous cardioplegic cardiac arrest be made, and what are the potential benefits and drawbacks of this approach?
  4. What is the expected recovery time and post-operative care following sternotomy with percutaneous cardioplegic cardiac arrest?
  5. How will my ongoing care be managed to minimize the risk of complications or reoperation in the future?

Reference

Authors: Mehta AR, Hammond B, Unai S, Navia JL, Gillinov M, Pettersson GB. Journal: J Thorac Cardiovasc Surg. 2021 May;161(5):1724-1730. doi: 10.1016/j.jtcvs.2019.09.191. Epub 2019 Nov 16. PMID: 31924356