scholarly journals Factors influencing sternal healing and comparison of different sternal closure methods: a retrospective analysis

2021 ◽  
Author(s):  
Xuanren Long ◽  
Kun Mei ◽  
Yongxiang Qian ◽  
Xiaoyin Zhang ◽  
Min Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Retrospective Analysis ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Steel Wire ◽  
Median Sternotomy ◽  
Transverse Displacement ◽  
Sternal Closure ◽  
Internal Mammary ◽  
Healing Group

Abstract Background We determined the factors affecting sternum healing after a median sternotomy based on a retrospective analysis; additionally, we compared the stability of different sternal closure techniques. Methods We collected information involving patients who underwent a median sternotomy in Changzhou First People's Hospital from 2014–2019 and who had chest CT examinations at 1–24 months post-operation. The main outcome included the average sternal healing score at the five specific anatomic levels and adverse events of transverse displacement of the sternum. Results In the short-term healing group, the sternal score was only correlated with postoperative time (HR = 0.18, 95% CI: 0.135–0.225, p < 0.001). In the long-term healing group, older people had a higher risk of poor sternal healing than young people (age, HR=-0.028, 95% CI: -0.05–0.006, p = 0.013). Patients with left internal mammary artery dissociation (LIMA-d) had a high risk of poor sternal healing (HR=-0.444, 95% CI: -0.869-0.019, p = 0.045). The binary logistic regression showed that steel wire fixation was a favorable factor for preventing transverse displacement of the sternum (HR = 0.122, 95% CI: 0.007–0.651, p = 0.047). Conclusion In summary, advanced age and internal mammary artery interception are risk factors that affect sternal healing, based on the imaging findings. This new method of sternal closure provides an effective way of ensuring sternal stability of both sternal plates and reduces the risk for complications after cardiac surgery in high-risk patients.

scholarly journals Influence Factors of Sternal Healing and Comparison of Different Sternal Closure Methods：A Retrospective Analysis

2021 ◽  
Author(s):  
Xuanren Long ◽  
Kun Mei ◽  
Yongxiang Qian ◽  
Xiaoyin Zhang ◽  
Bin Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Retrospective Analysis ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Steel Wire ◽  
Median Sternotomy ◽  
Transverse Displacement ◽  
Sternal Closure ◽  
Internal Mammary ◽  
Healing Group

Abstract Background We determined the factors affecting sternum healing after a median sternotomy based on a retrospective analysis and compared the stability of different sternal closure techniques. Methods We collected information involving patients who underwent a median sternotomy in Changzhou First Hospital from 2014–2019 and had chest CT examinations 1–24 months postoperative, Main outcome includes the average of sternal healing score at the five specific anatomic levels and the adverse event of transverse displacement of sternum. Results In the short term healing group, Sternal score was only correlated with postoperative time (HR = 0.18, 95%CI:0.135–0.225, p < 0.001). In the long term healing group,old people had a higher risk of poor sternal healing than young (Age, HR=-0.028,95%CI:-0.05,-0.006, p = 0.013). Patients with left internal mammary artery grafting (LIMAG) had a high risk of poor sternal healing (HR=-0.444, CI:-0.869-0.019, p = 0.045).By binary logistic regression, It could be found that steel wire fixation was a favorable factor to prevent the transverse displacement of sternum (HR = 0.122, 95%CI:0.007–0.651, p = 0.047). Conclusion In summary, advanced age and internal mammary artery interception are risk factors that affect sternal healing based on imaging findings. this new method of sternal closure provides an effective way of ensuring sternal stability of both sternal plates and reduces the risk for complication after cardiac surgery in high-risk patients.

scholarly journals Treatment of an Unusual Occurrence of a Complex Left Subclavian Artery/Left Internal Mammary Artery Bifurcation Stenosis in the Setting of Coronary Subclavian Steal Syndrome and Ischemic Left Ventricular Systolic Dysfunction

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Michael J. Martinelli ◽  
Michael B. Martinelli
Keyword(s):  
Subclavian Artery ◽  
Internal Mammary Artery ◽  
Left Subclavian Artery ◽  
Left Internal Mammary Artery ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Subclavian Steal Syndrome ◽  
Internal Mammary ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

This case will illustrate the clinical and unique technical challenges, not previously reported, in a patient with a history of progressive left ventricular (LV) systolic dysfunction, congestive heart failure (CHF), myocardial infarction (MI), and a complex bifurcation lesion of the left subclavian artery (SA) involving the left internal mammary artery (LIMA) in the setting of coronary subclavian steal syndrome (CSSS). The approach to this lesion is complicated by significant LIMA involvement requiring intervention directed toward both the SA and the LIMA in the presence of severe LV systolic dysfunction. This clinical scenario necessitates a careful technique, utilizing bifurcation methods similar to those used in coronary intervention.

scholarly journals Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Jonathan D. Gardner ◽  
William R. Maddox ◽  
Joe B. Calkins
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Coronary Vein ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients ◽  
Internal Mammary

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

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