Ann Thorac Surg 1997;64:1504-1505
© 1997 The Society of Thoracic Surgeons
How To Do It
Temporary Stenting of the Sternum After Difficult Cardiac Operations
Ganeshakrishnan K. Thyagarajan, MD,
Adnan Cobanoglu, MD
Division of Cardiopulmonary Surgery, Oregon Health Sciences University, Portland, Oregon
Accepted for publication June 13, 1997.
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Abstract
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Stenting the sternum may be essential to keep the sternal edges apart and optimize the hemodynamics in some patients, after cardiac operations. We have devised an effective stent that can be prepared very quickly from the equipment available in the operating room.
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Introduction
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See also page 1505
Some cardiac surgical procedures may result in severe myocardial edema, which in turn results in hemodynamic compromise on attempted sternal closure [1, 2]. Various methods to keep the sternal edges apart have been described [3–5]. We describe a stable, rigid stent that can be made quickly from the outer barrel of a syringe of the desired size, appropriate to the size of the patient.
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Technique
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When the sternal edges are found to compromise the hemodynamics on attempted closure, and it is deemed necessary to stent the sternum, an outer barrel of an appropriately sized syringe is selected and the ends are cut to the desired width of the stent (Figure 1a
). Both ends are notched to provide stable purchase on the sternal edges (Figure 1b). A stent ready to be placed is shown in Figure 2. The stent is then placed in such a way that the edges of the sternum fit snugly in the notch created, while the sternal retractor is removed (Fig 3). The stent may then be sutured to the edges of the sternum. A piece of sterile Esmark bandage (Currie Laboratories, Monrovia, CA) is then sutured to the skin edges providing a watertight seal over the stent. Sterile occlusive dressings are then placed over this.
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Fig 1. . Making the stent. (a) The ends of the outer barrel of a syringe are cut to make a hollow cylinder. (b) The cut ends of the syringe are notched; the sternal edges will fit snugly into the notches.
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Comment
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Severe myocardial edema may prevent sternal closure after difficult cardiac surgical procedures in severely ill patients. Even minor contact and pressure from the sternal edges may result in additional cardiac dysfunction [1, 2], thereby mandating the need for placement of a stent. A few methods to achieve this have been described [3–5]. Stents made of semirigid chest tubes tend to be unstable [5]. Spool-like stents made from multiple syringes have been used, but the width of the stent may be inadequate, as some patients may need a stent that will provide a wide separation of the sternal edges for optimizing the hemodynamics.
We have used the stent described in this report in 12 patients over the past 5 to 6 years and have found it to provide a stable chest wall, which in turn translates into easier transport and nursing care of these critically ill patients. The stenting method has been very effective in all cases, and we have not experienced any complications related to the device itself. This stent also can be tailored in width and height by selecting the appropriate size of the syringe, and may be used in pediatric as well as adult patients. These stents are easy to prepare with the supplies available in the operating room.
We believe this technique will be a useful tool in the armamentarium of the cardiac surgeon and will help in the management of these critically ill patients.
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Footnotes
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Address reprint requests to Dr Cobanoglu, Division of Cardiopulmonary Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, L-353, Portland, OR 97201-3098.
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References
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- Shore DF, Capuani A, Lincoln C. Atypical tamponade after cardiac operations in infants and children. J Thorac Cardiovasc Surg 1982;83:449–52.[Abstract]
- Gielchinsky I, Parsonnet V, Krishnan B, Silidker M, Abel R. Delayed sternal closure following open heart operations. Ann Thorac Surg 1981;32:273–7.[Abstract]
- Stark J. Surgical approaches. In: Stark J, de Leval M, eds. Surgery for congenital heart defects. 2nd ed. Philadelphia: Saunders, 1993:235–45.
- Jones SD, Fullerton DA, Campbell DN, et al. Technique to stent the open sternum after cardiac operations. Ann Thorac Surg 1994;58:1186–7.[Abstract]
- Satoh H, Sakai K, Koyama M, Matsuda H. Spool-like stent for the open sternum after cardiac operations. Ann Thorac Surg 1997;63:572–4.[Abstract/Free Full Text]
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Abstract
Introduction
