Comparing Short-Term Outcomes of Right Mini-Thoracotomy and Median Sternotomy for Isolated Left Atrial Myxoma Excision

Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to compare early postoperative outcomes between two surgical approaches—right mini-thoracotomy and median sternotomy—for the removal of isolated left atrial myxoma. Methods: We conducted a prospective observational study at the Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute (NHFH&RI), Mirpur, Dhaka, from March 2017 to August 2019. Twenty-eight patients undergoing surgery for isolated left atrial myxoma were included. The surgical approach was determined by the operating surgeon. We analyzed outcomes like intubation time, Intensive Care Unit (ICU) stay, pain levels (Visual Analogue Scale score), and overall hospital stay using SPSS. Statistical significance was set at p Results: Patients in the right mini-thoracotomy group had longer mean intubation times (11.43 vs. 5.93 hours, p Conclusion: Despite longer intubation and ICU times, the right mini-thoracotomy approach offers a minimally invasive alternative for isolated left atrial myxoma excision, with favorable outcomes overall.

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability

AIM: To increase the stability of sternotomy and so decrease the complications because of instability. METHODS: Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costa joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-stee wiring. Fatigue testing was performed in craniocaudal, anterio-posterior(AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s(0.2 Hz). The amount of displacement in AP, lateral and craniocaudal directions were measured and also the op-posing bone surface at the osteotomy areas were calculated at the two halves of sternum. RESULTS: The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm2 for median sternotomy and was 16.8 ± 0.78 cm2 for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1.CONCLUSION: Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

Comparison of Partial Upper Sternotomy Versus Median Sternotomy for Total Arch Replacement in Patients With Type A Aortic Dissection

Objective:Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare,and the safety and benefits of partial upper sternotomy need further evaluation.This study aimed to explore the effectiveness and prognosis of partial upper sternotomy in total arch replacement among patients with type A aortic dissection.Methods:This is a retrospective study of patients who underwent total arch replacement for type A aortic dissection at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2016 and December 2019.They were grouped into the median sternotomy and partial upper sternotomy groups according to the different treatment methodologies.The intra-operative and prognostic indicators were compared between both groups.Results:Forty-nine patients were included:31 in the median sternotomy group and 18 in the partial upper sternotomy group.The partial upper sternotomy group had a shorter incision((9.0±0.8)cm vs.(25.5±1.3)cm,P=0.02)and smaller postoperative total drainage volume(885mL vs.1,820mL,P=0.03)than the median sternotomy group.The differences between the 2 groups with respect to other intra-operative indicators such as operation duration,cardiopulmonary bypass duration,aortic occlusion duration,hypothermic circulatory arrest duration,and intra-operative blood loss,and prognostic indicators such as red blood cell infusion,ventilator aid duration,cardiac intensive care unit stay,postoperative hospital stay,and postoperative complications were not significantly different(all P>0.05).Conclusions:The utilization of partial upper sternotomy in patients with type A aortic dissection resulted in a smaller incision and more aesthetically pleasing scar,along with reduced drainage volume compared to median sternotomy.

The Effects of Laser Therapy in Treating Hypertrophic Scars and Keloids after Median Sternotomy:A Scoping Review

Background:Hypertrophic scars and keloids,common complications following median sternotomy for cardiac surgery,significantly impact patient quality of life due to their aesthetic and symptomatic burden.Recent advancements in laser therapy have made it a prominent option for managing these complex scars,yet a com-prehensive understanding of its efficacy is lacking.The aim of this scoping review is to explore the effects of laser therapy in managing hypertrophic scars and keloids after median sternotomy.Methods:This scoping review ana-lyzed studies up to February 2024 from databases including PubMed,EMBASE,CINAHL,Scopus,Web of Science,and the Cochrane Library.We included any study that assessed laser therapy’s effects on hypertrophic scars and keloids following median sternotomy.Studies were selected based on predefined inclusion criteria with-out publication year,design,or origin restrictions.Results:Six studies met the inclusion criteria,involving a total offive RCTs and one review.These studies primarily tested 585 and 595-nm pulsed dye laser(PDL)treatments,focusing on scar appearance,patient symptoms,and treatment satisfaction.Most studies reported significant improvements in scar height reduction and patient symptom relief after treatment,with mixed results for scar erythema and elasticity.Adverse events were generally mild and transient.Conclusions:Laser therapy offers a beneficial approach for improving the appearance and symptoms of hypertrophic scars and keloids post-median sternotomy.However,further research is necessary to optimize treatment parameters and explore the long-term psychosocial impacts of this therapy.This review highlights the need for more comprehensive studies to establish standardized treatment protocols and evaluate their effectiveness.

Management of sternal osteomyelitis and mediastinal infection following median sternotomy

Background Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps （BPMMF） for management of sternal osteomyelitis and mediastinal infection following median sternotomy.Methods Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.Results No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.Conclusions Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged stermal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Objective： Mitral valve disease tends to be treated with anterolateral minithoracotomy （ALMT） rather than median stemotomy （MS）, as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods： One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results： ALMT showed a significantly longer cardiopulmonary bypass time （P=0.001） and aortic cross-clamp time （P=0.05） compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay （P〈0.00001）. According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS （P=0.05）; however, the incidence of peri-operative mortality （P=0.62）, re-operation for bleeding （P=0.37）, neurologic events （P=0.77）, myocardial infarction （P=0.84）, gastrointestinal complications （P=0.89）, and renal insufficiency （P=0.67） were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions： Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

The effect of surgical skin tension reduction combined with early electronic line irradiation on keloid treatment after median sternotomy

Background Median sternotomy remains the preferred technique in open heart surgery. The middle part of the chest is a predilection site for keloids. Keloids are often accompanied by itching and pain, and seriously affect the beauty and quality of life. The main treatments of keloids include surgical resection, local injection of drugs, laser, cryotherapy, compression therapy, and topical application of silica gel. Unfortunately, there is no way to achieve superior results. Therefore, there is a need to find an effective way to treat keloid after median sternoto- my. Our study was designed to investigate the effect of reducing the tension of the skin and the early electronic line irradiation on the treatment of keloid after median sternotomy. Methods A retrospective analysis was per- formed in 54 patients with keloid after median sternotomy treated by reducing the tension of the skin and remov- ing the keloid, followed with electron beam irradiation treatment 24 hours after the operation. For each patient, 5 Gy electron beam irradiation was used every day after the operation for 4 days with the total dose of 20 Gy. The patients were followed up at 6 months and 12 months after surgery. Results Fifty-four cases of patients were followed up for at least 6 months. In 6 months follow-up, there were significant effects in 34 cases with a total effective rate of 98.1%. In 12 months follow-up, 33 cases were cured with the total effective rate was 96.3%. Conclusion The treatment of keloid after median sternotomy can be achieved by the combination of tension re- duction surgery and early electronic line irradiation.

Effect of acupuncture on short-term pain after standard thoracotomy

Background:To observe the effect of perioperative acupuncture on postoperative pain in patients undergoing standard sternotomy.Methods:57 patients who received standard median sternotomy were randomly divided into acupuncture group(30 cases)and control group(27 cases).The control group was treated with routine operation and nursing,and the acupuncture group was treated with acupuncture for 10 days on the basis of perioperative period.The pain levels of the two groups before and after operation were compared.Results:The pain level of the acupuncture group was significantly lower than that of the control group on the 2nd,10th,and 30th days after operation(P<0.05),and the short-term pain levels in the two groups were statistically significant(P<0.05).Conclusion:The perioperative acupuncture treatment has a significant analgesic effect on short-term pain for patients undergoing anterior midline thoracotomy,and it is helpful for patients to recover quickly after surgery.

Deep Sternal Wound Infections after Coronary Artery Bypass Grafting: Analysis of 29 Cases from Iraq

Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m2. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.