Pros and cons of urgent exploratory sternotomy after open cardiac surgery.
To determine whether it is appropriate to perform urgent exploratory sternotomy for potentially life-threatening complications of open-heart procedures, the authors reviewed the charts of 100 such patients managed by exploratory sternotomy between December 1982 and December 1984. Group 1 comprised 32 patients who suffered cardiac arrest (8) or had acute profound hypotension (24). Group 2 included 68 patients with persistent excessive bleeding. Of group 1 patients operated because of acute profound hypotension, 50% had definite evidence of cardiac tamponade. In the remainder the cause was severe myocardial ischemia and left ventricular failure. In group 2 an identifiable correctable site of bleeding was found in 78%. Four of the 8 patients with cardiac arrest and 20 (83%) of the 24 patients with acute profound hypotension survived and left the hospital. In group 2, 58 (85%) of the 68 survived. The mean postoperative stay was higher in group 1 than group 2-20.3 +/- 3.08 days versus 14.2 +/- 1.23 days (p less than 0.1). The duration of ventilatory support in group 1 was also higher - 6.18 +/- 1.32 days versus 2.12 +/- 0.38 days. Postoperatively, sputum cultures gave positive results in 19% of the patients, all of whom had required prolonged ventilatory support. Minor sternal wound infections were present in two and major in four. There was no significant difference in morbidity of the survivors between those who underwent sternotomy in the recovery room or in the operating room.(ABSTRACT TRUNCATED AT 250 WORDS)
Koshal
A
A
Murphy
J
J
Keon
W J
WJ
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006323:Heart Arrest / Q000601:surgery; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D013249:Sternum / Q000601:surgery*