Reversed-J inferior versus full median sternotomy: which is better for awake coronary bypass surgery.
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.
Kirali
Kaan
K
Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
Kayalar
Nihan
N
Ozen
Yücel
Y
Sareyyüpoğlu
Başar
B
Güzelmeriç
Füsun
F
Koçak
Tuncer
T
Yakut
Cevat
C
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
D010100:Oxygen