Our Summary

This research paper is a review of 25 years of data from a German university medical center. It looks at the frequency, outcomes, and complications of different types of open heart surgery. The study included 104 patients, who were on average 64 years old. According to the EuroSCORE II, a method for evaluating the risk of death from heart surgery, these patients had an average risk of dying of about 16%.

The study compared different types of surgery, including coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve replacement. The risks associated with these procedures were generally similar, except that over half of the patients scheduled for CABG surgery had recently had a heart attack.

The time between surgeries for these patients was about five years on average. The most common surgeries were valve operations, which were performed on about 70% of patients, while only about 22% of patients had coronary bypass surgery. Some patients had more than one procedure done at the same time.

In some cases, complex surgery to replace the aortic arch was necessary. This procedure is known as a “frozen elephant trunk” procedure. The 30-day survival rate after surgery was about 82%.

The study concluded that having a third or subsequent sternotomy (surgery involving cutting through the breastbone) offers a reasonable outcome and should be considered for suitable patients.

FAQs

  1. What is the average mortality risk of sternotomy procedures according to the EuroSCORE II?
  2. What are the most frequent surgical procedures performed along with sternotomy?
  3. What is the 30-day survival rate for patients who undergo third-time or more sternotomy procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions closely, including avoiding heavy lifting and strenuous activities for a certain period of time to allow the sternum to heal properly. It is also important to attend follow-up appointments and notify your doctor if you experience any unusual symptoms such as chest pain or difficulty breathing. By following these guidelines, you can help ensure a successful recovery from sternotomy surgery.

Suitable For

Patients who are typically recommended sternotomy are those who require complex open heart procedures, such as reoperative surgery, valve replacement, aortic arch replacement, and coronary artery bypass grafting. These patients may have had previous cardiac surgeries and have a higher risk for complications. The study mentioned in the abstract found that third-time or more sternotomy procedures had an acceptable outcome in appropriate patients, with a 30-day survival rate of 81.7%. The EuroSCORE II calculated an average mortality risk of 15.7%, indicating that these patients may have a higher risk for complications. Overall, sternotomy may be recommended for patients who require complex open heart procedures, despite the potential risks involved.

Timeline

Before Sternotomy:

  • Patient is diagnosed with a cardiac condition that requires open heart surgery
  • Patient undergoes preoperative evaluations and tests to assess their overall health and surgical risk
  • Surgery is scheduled and patient undergoes sternotomy procedure, which involves cutting through the breastbone to access the heart
  • Surgery is performed to address the cardiac condition, such as coronary artery bypass grafting (CABG), aortic valve replacement, or mitral valve replacement

After Sternotomy:

  • Patient is monitored closely in the intensive care unit (ICU) immediately following surgery
  • Patient may experience pain, discomfort, and limited mobility due to the sternotomy incision
  • Patient undergoes postoperative care, including medication management, physical therapy, and monitoring of vital signs
  • Patient is discharged from the hospital after a few days to a week, depending on recovery progress
  • Patient undergoes follow-up appointments with the surgical team to monitor healing and address any complications or concerns
  • Patient resumes normal activities and may experience improved cardiac function and quality of life as a result of the surgery.

What to Ask Your Doctor

  1. What specific risks are associated with undergoing a third-time or more sternotomy procedure?
  2. How does my individual risk profile, as determined by the EuroSCORE II, affect the likelihood of a successful outcome?
  3. How does the time interval since my previous surgery impact the complexity and potential risks of the sternotomy procedure?
  4. Are there any alternative treatment options to consider before proceeding with a sternotomy procedure?
  5. What steps will be taken to minimize the risk of complications during and after the surgery?
  6. How long is the expected recovery time following a sternotomy procedure, and what can I do to support my recovery?
  7. Will I require any additional follow-up care or monitoring after the procedure, and what signs should I watch for that may indicate a potential issue?
  8. Are there any specific lifestyle changes or precautions I should take to reduce the risk of needing further sternotomy procedures in the future?
  9. How often will I need to follow up with my healthcare team after the sternotomy procedure to monitor my heart health and overall well-being?

Reference

Authors: Rupprecht L, Schopka S, Keyser A, Lunz D, Sossalla S, Hilker M, Schmid C. Journal: Thorac Cardiovasc Surg. 2022 Aug;70(5):377-383. doi: 10.1055/s-0040-1719157. Epub 2020 Dec 24. PMID: 33368107