Multiple graft injury due to migrated non-broken sternal wires two years
after cardiac surgery
Abstract
Migration of sternal wires into vital structures is a rare but
potentially life-threatening complication. While a few cases have been
reported, 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 and migration
of several non-broken sternal wires into the vascular grafts. 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. Polypropylene sutures were placed to
control bleeding.