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Does deflating the lungs and sawing from the xiphisternum reduce the chance of accidental pleurotomy during sternotomy?

¹ The Department of Cardiothoracic surgery, Freeman Hospital, Newcastle-upon-Tyne, UK
² Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel./fax: +44-780-1548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether deflating the lungs or sawing from the xiphisternum, reduces the incidence of accidental pleurotomy when performing a sternotomy. Altogether 170 papers were identified using the below mentioned search, of which 4 papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. We conclude that disconnection of the ventilator prior to sternotomy cannot be supported as a strategy to reduce the incidence of accidental pleurotomy. In addition there is little evidence to support sternotomy from the Xiphoid process upwards over sternal notch downwards.

Key Words: Evidence-based medicine; Thoracic surgery; Sternum; Pleura