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ABSTRACT 92
TO CLICK OR
..NOT TO CLICK
Murali Dharan, MD, Shahroukh Bakhshay, MD, Lisa Nichols,
RN
Bay Area Heart Institute, San Ramon Regional Medical Center, San
Ramon, CA. 94583 USA
In traditional CABG using a full sternotomy approach, a sternal
click can be an ominous sign that frequently mandates a return
to the operating room.
Purpose: To determine the significance of sternal
click in manubrium sparing ministernotomy (MS), for patients undergoing
off-pump coronary artery bypass grafting (OPCAB).
Methods: From January 2000 to October 2000,
120 patients underwent MS and OPCAB. The incision is a partial
transverse sternotomy on the left side below the manubrium. The
rest of the MS is completed from the xiphoid in the form of an
inverted L. Four patients were converted to a full sternotomy
for optimal visualization of lateral targets. One for placement
on cardiopulmonary bypass (CPB) and two patients were placed on
CPB through a femoral approach. All of the MS were closed with
four #7 stainless steel wires in the 4th 7th
intercostal spaces.
Summary of Results: None of the patients
had deep sternal wound infections. Sixteen (13%) of the patients
complained of a sternal click in the postoperative period. The
sternal clicks resolved within two weeks in 90% of patients (n=14),
and within three weeks in all patients. None of the patients developed
sternal dehiscence or infection.
Conclusions: We conclude that sternal clicks commonly
occur after MS, but they are benign and should be observed. There
is no role for surgical re-intervention in these patients. This
is self-limiting and disappears without any sequelae in 3 weeks.
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