title: Reversed-J inferior versus full median sternotomy: which is better for awake coronary bypass surgery.
abstract: 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 PaCO2 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.
authors.affiliation: Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
authors.forename: Nihan
authors.initials: N
authors.lastname: Kayalar
authors.forename: Yücel
authors.initials: Y
authors.lastname: Ozen
authors.forename: Başar
authors.initials: B
authors.lastname: Sareyyüpoğlu
authors.forename: Füsun
authors.initials: F
authors.lastname: Güzelmeriç
authors.forename: Tuncer
authors.initials: T
authors.lastname: Koçak
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010100:Oxygen / Q000097:blood; D012119:Respiration; D013249:Sternum / Q000601:surgery*; D014851:Wakefulness
chemical_list: D010100:Oxygen