Our Summary

This study looked at the reasons why a surgical procedure to replace a damaged aortic valve, known as a sternotomy, might need to be stopped unexpectedly in patients with aortic stenosis. The data for this was gathered from five different medical centers between 2009 and 2014. The most common reason for having to stop this procedure was the discovery of a condition known as “porcelain aorta,” which makes the aorta brittle and difficult to operate on. Other reasons included fibrosis caused by radiotherapy and chronic inflammation of the tissue surrounding the heart.

After the procedure was stopped, most patients had to wait around 2.3 months until the next intervention, with no deaths occurring during this waiting period. Only one patient had to undergo open surgery. In the majority of cases, a less invasive procedure known as Transcatheter Aortic Valve Implantation (TAVI) was performed with a high success rate. However, some patients did experience complications such as heart failure, major bleeding, and acute kidney injury. The data also showed that older patients, those who had previous heart surgery, and those who had to wait less time until their next procedure had a higher risk of dying within six months.

The study concludes that the most common reason for stopping a sternotomy is porcelain aorta, which is associated with a higher rate of complications and death, especially in older patients and those with a history of heart surgery. To prevent this, the researchers suggest conducting imaging evaluations in these higher-risk groups. They also note that TAVI was the most commonly used treatment approach after a stopped sternotomy.

FAQs

  1. What are the main reasons for an aborted sternotomy in aortic stenosis patients?
  2. What is the most common management strategy after an aborted sternotomy?
  3. What factors are associated with a higher six-month mortality rate after an aborted sternotomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to ensure they undergo thorough imaging evaluation before the procedure, especially if they are older or have a history of prior cardiac surgery. This can help identify any potential risk factors, such as a porcelain aorta, that may lead to the need for an aborted sternotomy. By being proactive and addressing these issues before surgery, complications and mortality rates can potentially be reduced.

Suitable For

Patients who are typically recommended sternotomy include those with severe aortic stenosis who are accepted for surgical aortic valve replacement (SAVR) but may have unexpected complications such as a porcelain aorta, mediastinal fibrosis due to radiotherapy, or chronic mediastinitis. Patients who are older, have had previous cardiac surgery, and have a shorter time from aborted sternotomy to next intervention may be at higher risk for complications and mortality. In these cases, transcatheter aortic valve implantation (TAVI) may be a more suitable alternative treatment option. Preventive strategies, such as imaging evaluation, may be considered for patients at higher risk of complications during sternotomy.

Timeline

  • Patients with aortic stenosis are accepted for surgical aortic valve replacement (SAVR)
  • Unexpected need to abort sternotomy occurs in some patients
  • Main reasons for aborted sternotomy include previously unknown porcelain aorta, mediastinal fibrosis due to radiotherapy, and chronic mediastinitis
  • Median time between aborted sternotomy and next intervention is 2.3 months
  • Only one case was managed with open surgery, while 30 patients underwent transcatheter aortic valve implantation (TAVI)
  • In-hospital mortality rate was 9.7% and complications included heart failure, major bleeding, and acute kidney injury
  • Older patients, those with previous cardiac surgery, and shorter time from aborted sternotomy to next intervention were related to higher six-month mortality
  • Imaging evaluation may be a preventive strategy for patients with porcelain aorta or prior cardiac surgery
  • TAVI was the most common therapy used after aborted sternotomy.

What to Ask Your Doctor

  1. What are the potential reasons for an aborted sternotomy in aortic stenosis patients accepted for surgical aortic valve replacement?
  2. How common is the occurrence of aborted sternotomy in this patient population?
  3. What are the main complications and outcomes associated with an aborted sternotomy?
  4. How is an aborted sternotomy typically managed, and what are the treatment options available?
  5. Are there any specific risk factors or conditions that may increase the likelihood of needing to abort a sternotomy?
  6. What imaging evaluations or diagnostic tests can be done to potentially prevent the need for an aborted sternotomy in high-risk patients?
  7. What are the potential long-term implications or risks for patients who have undergone an aborted sternotomy?
  8. Is transcatheter aortic valve implantation (TAVI) a common alternative or follow-up treatment option for patients who have had an aborted sternotomy?
  9. How does the presence of a porcelain aorta or previous cardiac surgery impact the likelihood of needing to abort a sternotomy and the overall prognosis?
  10. Are there any specific follow-up care or monitoring recommendations for patients who have experienced an aborted sternotomy?

Reference

Authors: Castrodeza J, Amat-Santos IJ, Serra V, Nombela-Franco L, Brinster DR, Gutiérrez-Ibanes E, Rojas P, Tornos P, Carnero M, Cortes C, Tobar J, Di Stefano S, Gomez I, San Román JA. Journal: Int J Cardiol. 2016 Nov 15;223:1019-1024. doi: 10.1016/j.ijcard.2016.08.301. Epub 2016 Aug 23. PMID: 27592044