Stroke debility during non-full sternotomy versus full sternotomy access cardiac valve operations

Objective

Previous studies have reported an increased risk of stroke with non-full sternotomy access during cardiac valve operations, but the clinical significance of these strokes has not yet been explored. We sought to determine the incidence and clinical magnitude of postoperative stroke following non-full versus full sternotomy access.

Methods

We analyzed the records of 12,406 patients who underwent a cardiac valve operation with full median sternotomy (n = 10,863; 88%), partial sternotomy (n = 219; 1.8%), or thoracotomy (n = 1324; 11%) access between January 1997 and March 2021. The primary outcome was permanent stroke, categorized using the modified Rankin Scale (mRS; score 0-6) at discharge. Multivariable logistic regression analysis was used to assess the risk of stroke.

Results

The rate of stroke was 1.0% in the full sternotomy group, 2.7% in the partial sternotomy group, and 1.2% in the thoracotomy group (P = .044). The majority of strokes were mildly disabling (mRS ≤2), both overall (n = 82; 62%) and in each group (range, 60%-69%). There was an increased risk of stroke with partial versus full sternotomy (odds ratio [OR], 3.73; 95% confidence interval [CI], 1.59-8.78; P = .010) but not with thoracotomy versus full sternotomy (OR, 1.34; 95% CI, 0.48-3.77). There was no differential effect of sternotomy type on stroke risk according to type of valve operation (P = .985). Stroke-related mortality was uncommon (1.3%).

Conclusions

Partial sternotomy versus full sternotomy is associated with increased risk of stroke, whereas thoracotomy versus full sternotomy is not. The risk of stroke is low, with most strokes being only mildly disabling.