ABSTRACT
To evaluate the impact of internal mammary artery harvesting on sternal blood supply after open heart surgery, a conventional bone scan was performed 7 days after operation in 30 patients. After administration of 370 MBq of technetium 99 m-medronic acid complex, imaging was carried out at the level of the sternum and including the humerus as a reference. A quantitative analysis of uptake (sternum/humerus uptake index) was performed and compared in three different groups of patients: group A, ten patients who had only vein grafts or valve surgery; group B, ten patients with single internal mammary artery harvesting; and group C, ten patients with bilateral internal mammary artery harvesting. These results were compared with 24 non-surgical subjects as a control (group D). Although intervention had a significant influence in raising the uptake index of the surgical groups (A = 3.34; B = 3.09 and C = 3.48) when compared with normal subjects (D = 2.45) (P < 0.01), there was not a statistically significant difference among the three surgical groups (P > 0.05). It was concluded that the vascular supply of the sternum is not entirely dependent upon the internal mammary arteries and that mobilization of both vessels does not cause per se additional serious impact to the bone vascularization after midline sternotomy, at least beyond day 7 after operation.
Subject(s)
Mammary Arteries/surgery , Sternum/blood supply , Technetium Tc 99m Medronate , Coronary Artery Bypass , Female , Humans , Humerus/diagnostic imaging , Humerus/metabolism , Male , Myocardial Revascularization/methods , Prospective Studies , Radionuclide Imaging , Saphenous Vein/transplantation , Sternum/diagnostic imaging , Sternum/metabolism , Sternum/surgery , Technetium Tc 99m Medronate/pharmacokinetics , ThoracotomyABSTRACT
Mediastinal bleeding can be a problem after cardiac surgery, either as a result of coagulation derangements or technical problems. We evaluated 100 patients, treated with temporary chest packing for intractable bleeding, of 9,383 undergoing open heart operations during a 10-year period. Preoperatively, 60 of these patients had one or more predisposing factors for bleeding. There were four predominant sites of hemorrhage: general ooze, needle holes of the aortic and atrial suture lines, inaccessible origin, and another specific place. The chest was packed in the operating room in 84 patients and in the intensive care unit in 16. Four methods of temporary chest closure were used: the skin alone, partial sternal approximation plus skin closure, full closure, and the wound open and covered by a Steri-drape dressing. The bleeding was controlled in 65 patients who had been packed once, and in 29 patients after reexploration and multiple packings, for a total of 94 patients (94%). Sternal wound infection, generalized sepsis, and sternal dehiscence was present in 24 patients, 8 of whom died. The venue for inserting or removing the packs did not affect the incidence of infections. Our experience suggests that packing of the chest after cardiac procedures for intractable bleeding allows a reasonable patient salvage rate and complication risks.
