Comparative Analysis of Thoracotomy and Sternotomy Approaches in Cardiac Reoperation

Kim, Dong Chan; Chee, Hyun Keun; Song, Meong Gun; Shin, Je Kyoun; Kim, Jun Seok; Lee, Song Am; Park, Jae Bum

Abstract

BACKGROUND
Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation.
MATERIALS AND METHODS
From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months).
RESULTS
Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group.
CONCLUSION
The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.