Our Summary

This research paper focuses on the role of a specific type of CT scan, called multidetector CT (MDCT), in planning for repeat heart surgeries. Redoing a heart surgery, or resternotomy, can be risky due to potential injury to previous grafts, excessive bleeding, and high rates of illness and death during or after the operation. To reduce these risks, the researchers used MDCT to study various structures and distances within the heart and chest area before performing the surgery. They also assessed the condition of the aorta (the main artery that carries blood away from the heart), possible sites for inserting a cannula (a tube for administering or removing fluids), and other significant findings. Based on this information, surgeons were able to plan and adjust their surgical strategies for safer operations and better outcomes. The paper concludes that MDCT is a useful tool for making repeat heart surgeries safer and reducing the risk of negative outcomes. It also suggests that radiologists (medical professionals who interpret medical images like CT scans) should be aware of potential surgical options and include in their reports any findings that might be relevant to complications of resternotomy.

FAQs

  1. What are the potential risks associated with resternotomy in cardiac surgery?
  2. How does multidetector CT (MDCT) contribute to the safety of repeat cardiac surgery?
  3. What are the key factors evaluated during MDCT in planning for resternotomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to ensure they follow all post-operative care instructions carefully to promote proper healing of the sternum. This may include avoiding strenuous activities, taking prescribed medications as directed, and attending follow-up appointments with their healthcare provider. It is also important to report any unusual symptoms or signs of infection to their doctor promptly.

Suitable For

Patients who may be recommended sternotomy include those who require repeat cardiac surgery, such as coronary artery bypass grafting, valve replacement or repair, or other complex cardiac procedures. These patients may have had previous cardiac surgeries that have resulted in sternal abnormalities or complications, making a resternotomy necessary. Patients with sternal complications, such as sternal dehiscence, infection, or sternal wire fracture, may also be recommended for sternotomy to address these issues. Additionally, patients with a history of aortic surgery or other thoracic procedures may require sternotomy for access to the heart or surrounding structures.

Timeline

  • Pre-sternotomy: A patient undergoes a preoperative evaluation, including medical history, physical examination, and imaging studies such as MDCT to assess sternal compartment abnormalities, aorta, right ventricle, diaphragm, pericardium, innominate vein, and graft patency. Surgeons plan operative strategies based on these findings to mitigate the risks associated with resternotomy.
  • During sternotomy: The patient undergoes a repeat cardiac surgery procedure, where the sternum is surgically divided to access the heart and surrounding structures. Surgeons use the information from MDCT to guide their approach and minimize potential complications.
  • Post-sternotomy: Following the surgery, the patient is closely monitored in the intensive care unit for any signs of complications, such as hemorrhage or injury to old conduits. The patient’s recovery is managed with a focus on minimizing pain, promoting wound healing, and preventing infection. With the use of MDCT and tailored operative strategies, the patient experiences reduced operative mortality and adverse outcomes, leading to a smoother recovery process.

What to Ask Your Doctor

  1. How will a sternotomy affect my recovery time compared to other surgical approaches?
  2. What are the potential risks and complications associated with a sternotomy procedure?
  3. How will the surgeon ensure the safety of my old conduits and cardiac structures during the sternotomy?
  4. Will additional imaging, such as a multidetector CT scan, be used to plan and guide the sternotomy procedure?
  5. What specific precautions will be taken to minimize the risk of catastrophic hemorrhage during the sternotomy?
  6. How will the surgeon address any abnormalities or complications that may be identified during the sternotomy procedure?
  7. What is the surgeon’s experience and success rate with performing sternotomy procedures?
  8. Will there be any specific post-operative care or precautions I need to take following a sternotomy procedure?
  9. What are the expected outcomes and recovery timeline for a sternotomy procedure in my specific case?
  10. Are there any alternative surgical approaches or techniques that could be considered instead of a sternotomy?

Reference

Authors: Valente T, Bocchini G, Rossi G, Sica G, Davison H, Scaglione M. Journal: Br J Radiol. 2019 Sep;92(1101):20170980. doi: 10.1259/bjr.20170980. Epub 2019 Jun 20. PMID: 31199672