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Anesth Analg 2003;97:1856-1857
© 2003 International Anesthesia Research Society

LETTERS TO THE EDITOR

Sternectomy After Cardiac Surgery: Noncardiac Surgery?

Guillermo Lema, MD, Jorge Urzua, MD, and Roberto Canessa, MD

Department of Anesthesiology, Catholic University School of Medicine, Santiago, Chile

To the Editor:

I read with great interest the article by Glantz et al. (1) reporting the incidence of myocardial ischemia during sternectomy shortly after cardiac surgery.

The incidence of ischemia, obtained by the authors in this group of patients, is a contribution to our knowledge on the subject. Myocardial ischemia was five times more frequent, (22.8% vs 4.25%), when sternectomy was performed during the first week after cardiac surgery. This is an interesting finding. However, patients who required reexploration earlier in the postoperative period could have been sicker or more hemodynamically unstable due to infection than those who showed symptoms at a later stage. This could explain by itself the differences in myocardial ischemia between groups. Also, it may be argued that surgery for wound complications is not really noncardiac surgery, rather the treatment for a postoperative complication, analogous to reexploration for surgical bleeding. This may preclude extrapolation of these findings to other populations.

Patients with sternal and mediastinal wound infection early after cardiac surgery belong to a unique high-risk population. Sternectomy performed very soon after surgery represents an aggressive treatment, due to the systemic repercussions of infection and possible hemodynamic instability. In our university hospital, in more than 14,000 open-heart procedures, we have never performed an sternectomy due to mediastinitis so early after cardiac operation.

There is still controversy in the literature regarding the appropriate time to perform noncardiac surgery after coronary artery bypass surgery (2). This study contributes needed information about myocardial infarction and ischemia, but it should be used cautiously due to the peculiar characteristics of the population studied.

References

  1. Glantz L, Ezri T, Cohen Y, et al. Perioperative myocardial ischemia in patients undergoing sternectomy shortly after coronary artery bypass grafting. Anesth Analg 2003; 96: 1566–71.[Abstract/Free Full Text]
  2. Park KW. Preoperative cardiology consultation. Anesthesiology 2003; 98: 754–62.[Medline]
 

Response

Lucio Glantz, MD

Department of Anesthesiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel

In Response:

The incidence of ischemic events during noncardiac surgery performed shortly after coronary artery bypass (CABG) surgery has not been previously characterized. We evaluate the incidence of cardiac complications in patients undergoing sternectomy soon after coronary surgery. I agree that these patients are a unique, very ill population and probably cannot be compared with those scheduled for noncardiac surgery after uncomplicated CABG surgery. I am confident that our article will promote further study to determine whether the results of our study are generalizable to patients undergoing noncardiac surgery soon after uneventful CABG surgery.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press