Median sternotomy in penetrating cardiac trauma , does it make a difference ?

Ahmed Ibrahim Abdelwahab; Ali Mohamed Abdelwahab; Ahmed Ibrahim Gadallah; Radwan Abdelsabour Mohamed; Mohamed Esmat Bakhiet; Yasser Hamdy Hussein

Ahmed Ibrahim Abdelwahab Department of Cardiothoracic Surgery, Faculty of Medicine, Assuit University, Assuit, Egypt
Ali Mohamed Abdelwahab Department of Cardiothoracic Surgery, Faculty of Medicine, Assuit University, Assuit, Egypt
Ahmed Ibrahim Gadallah Department of Cardiothoracic Surgery, Faculty of Medicine, Assuit University, Assuit, Egypt
Radwan Abdelsabour Mohamed Department of General Surgery, Faculty of Medicine, Assuit University, Assuit, Egypt
Mohamed Esmat Bakhiet Department of General Surgery, New Valley University, Egypt
Yasser Hamdy Hussein artment of Cardiothoracic Surgery, Faculty of Medicine, Assuit University, Assuit, Egypt

Keywords: Median sternotomy, Left lateral thoracotomy, Penetrating cardiac trauma

Abstract

Background: Studies comparing the outcomes of left lateral thoracotomy and median sternotomy in the management of penetrating cardiac trauma in the Egyptian setting are lacking, which motivated us to conduct the current study. This study aimed to compare the perioperative and short-term outcomes between median sternotomy and left anterior thoracotomy in the management of patients with penetrating cardiac injuries.

Methods: A total of 40 patients with penetrating cardiac trauma were included: 34 were males (85%), and 6 were females (15%). The mean age was 35.00 ± 10.83 years. Patients were allocated into two groups: Group A (n= 20) was managed with median sternotomy, and Group B (n= 20) was managed with left lateral thoracotomy. The study outcomes included operative time, intraoperative blood loss, postoperative pain score, duration of mechanical ventilation, length of ICU stay, postoperative complications and mortality.

Results: The right ventricle was the most common injury site (60% vs. 50%, p= 0.619 in Groups A and B, respectively). Left lateral thoracotomy was associated with longer operation times [3750 (1500 – 6000) vs. 185 (70 - 260) mins, p= 0.002]. Left lateral thoracotomy patients had longer ICU stays [5 (2 – 7) vs. 3 (2 – 5) days, p= 0.004] and hospital stays [7 (4 – 12) vs. 5 (4 – 7) days, p= 0.001]. There were no differences in wound infection, pericardial effusion, or mortality between the groups. The pain score was lower in the median sternotomy group postoperatively from day 2 to day 7.

Conclusion: Median sternotomy was associated with a significant decrease in operation time, blood loss, pain score, duration of ICU stay, and hospitalization period. The median sternotomy approach could be preferred over the thoracotomy approach in patients with penetrating cardiac injury.