Multiple graft injury due to migrated non-broken sternal wires two years after cardiac surgery
Takayuki Kadohama, MD, PhD, Daichi Takagi, MD, PhD, Takeshi Arai MD, and Hiroshi Yamamoto, MD, PhD,
Department of Cardiovascular surgery, Akita University Graduate School of Medicine,
Akita, Japan
Address for reprint requests and other correspondence: Takayuki Kadohama MD, PhD, Akita University Graduate School of Medicine, Department of Cardiovascular Surgery, Hondo 1-1-1, Akita, 018-8543, Japan
TEL +81-18-884-6135, FAX +81-18-836-2625, E-mail: tkadoha@med.akita-u.ac.jp
Key words: sternal wire, aortic injury, cardiac surgery
Word count: 483
Migration of sternal wires into vital structures is a rare but potentially life-threatening complication. While a few cases have been reported1-4, the sternal wires were broken in those cases. To our knowledge, this is the first report of multiple, non-broken migrated sternal wires stabbing vascular grafts. A 65-year-old woman with a long history of treatment for extended aortic pathology, which included replacement of the aortic root (Bentall procedure, coronary artery reconstruction with Piehler technique), aortic arch and thoracoabdominal aorta, as well as thoracic endovascular repair (TEVAR), underwent mitral valve replacement due to severe mitral regurgitation under third median sternotomy. The postoperative course was uneventful, and she was followed as an outpatient. Two years after the surgery, she complained of anterior chest discomfort. Computed tomography (CT) revealed hemorrhaging around the vascular grafts in the mediastinum (Fig. 1A) and migration of several non-broken sternal wires into the vascular grafts (Fig. 1B). We suspected graft injury due to the sternal wires, and open repair by reopening the sternotomy incision was performed. During redo sternotomy, massive bleeding occurred, so cardiopulmonary bypass was urgently established via femoral cannulation, and her body temperature was brought down. After careful dissection, tearing of the grafts at both the ascending aorta and left coronary artery was found under circulatory arrest with moderate hypothermia (Fig. 1C). Polypropylene sutures were placed to control bleeding. After surgery, a long hospital stay was required to treat the patient’s deep sternal infection, and she ultimately died due to severe heart failure one year after this operation.