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Ann Thorac Surg 2001;71:1068
© 2001 The Society of Thoracic Surgeons

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Correspondence

Complications on sternal reentry

^a Department of Thoracic and Cardiovascular Surgery, University Hospital, CHU Ave de la "Cote de Nacre", 14033 Caen, France

e-mail: massetti-m{at}chu-caen.fr

To the Editor

We read with great interest the article by Follis and colleagues [1]. This excellent work examines the role of resternotomy in cardiac reoperations to define the incidence of catastrophic hemorrhage.

In this study they reviewed their experience using the technique described by Akl and associates [2] in 1984, utilizing a sagittal oscillating saw. The results were compared with the practice of 1,116 surgeons contacted by questionnaire.

We appreciated very much the way the discussion was conducted, and particularly the review of the literature on the available methods of resternotomy. We agree that as operative techniques evolve and survival after cardiac operations improves the number of patients undergoing repeat sternotomy inevitably will continue to rise.

In this context we would like to make some comments. Cardiac reoperations represent 18% (10% valvular and 8% coronary) of our daily activity. Since January 1980, more than 800 cardiac reoperations were done at our institution. Resternotomy was performed utilizing a swiveling plaster saw with a 3 cm deep blade. Neither deaths, nor complications as defined by Follis and colleagues as catastrophic hemorrhage, were observed. This swiveling sagittal saw operates by vibrating action at more than 20,000 cycles/min. The higher vibrating frequency of the steel blade results in a less traumatic action on smooth tissue without losing effectiveness on bone tissue.

We stress the importance of using a vibrating saw with a higher rate of vibration than the sagittal oscillating saw. Moreover, the good results encouraged us to use it as a routine device for both first and redo sternotomies because of its safety and effectiveness.

References

1. Follis F.M., Pett S.B., Miller K.B., Wong R.S., Temes R.T., Wernly J.A. Catastrophic hemorrhage on sternal reentry: still a dreaded complication?. Ann Thorac Surg 1999;68:2215-2219.[Abstract/Free Full Text]
2. Akl B.F., Pett S.B., Wernly J.A. Use of sagittal oscillating saw for repeat sternotomy: a safer and simpler technique. Ann Thorac Surg 1984;38:646-647.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Massimo Massetti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bruno, P. Articles by Khayat, A. Search for Related Content PubMed PubMed Citation Articles by Bruno, P. Articles by Khayat, A. Related Collections Chest wall