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Reversed‐J Inferior Versus Full Median Sternotomy: Which Is Better for Awake Coronary Bypass Surgery
Author(s) -
Kirali Kaan,
Kayalar Nihan,
Özen Yücel,
Sareyyüpoğlu Başar,
Güzelmeriç Füsun,
Koçak Tuncer,
Yakut Cevat
Publication year - 2005
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2005.200506.x
Subject(s) - medicine , median sternotomy , anesthesia , intubation , surgery , minimally invasive cardiac surgery , artery , coronary artery bypass surgery , cardiothoracic surgery , anesthetic , internal thoracic artery , cardiac surgery , bypass grafting
Background: The aim of this study was to ascertain whether the approach with a less invasive reversed‐J inferior sternotomy could improve intraoperative patient compliance and postoperative recovery than the standard median sternotomy. Methods: Seventeen patients underwent elective single coronary artery bypass graft operation under high thoracic epidural anesthesia without endotracheal intubation. The reversed‐J sternotomy was performed in 10 patients (Group A) and full sternotomy in 7 patients (Group B). The technical and surgical difficulties, pulmonary functions (by spirometric tests) and hospital stay were assessed. Results: Through the reversed‐J sternotomy coronary revascularization was accomplished without any additional technical difficulties and with a good exposure of both the left anterior descending artery and the left internal thoracic artery. No conversion to standard sternotomy and no intubation were observed. Additional doses of local anesthetic at jugular notch was not required in Group A. Pleura was opened more in Group B (57% vs. 20%; p = 0.14). Oxygen saturation was better in Group A during the surgical procedure (98.8 ± 0.7% vs. 97.1 ± 2.1%; p = 0.033), however, intraoperative PaCO 2 was similar in both the groups. The patients in Group A were discharged from the hospital earlier (3.2 ± 1.5 vs. 7.3 ± 3.5 days; p = 0.004). Conclusions: Less invasive approach to coronary artery bypass graft operations is possible through combination of the high thoracic epidural anesthesia and a reversed‐J sternotomy. This technique is less traumatic for patient and provides practical better oxygenation and shorter hospital stay.