الفهرس 
ACNOWLEDGEMENT
Cardiac TraumaOnly 14 pages are availabe for public view
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Abstract
Penetrating cardiac injuries are infrequent, with only10–14 % of patients surviving to evaluation in the emergency department. Although the injury is highly lethal, rapid surgical intervention may result in the survival of 24–60 % of those who arrive with signs of life. Despite capability, identifying these patients and providing the subsequent care are often challenging and resource intensive. Median sternotomy and thoracotomy are two options to explore any trauma to the chest. Surgeon generally decides the technique of approach in the operating room considering the site of injury and presence of an accompanying pulmonary injury. In the current prospective cohort study, we aimed to evaluate the effects of median sternotomy versus left lateral thoracotomy in penetrating cardiac trauma regarding the morbidity and mortality. We included a total of 40 patients presented with penetrating cardiac trauma to our trauma unit in Assiut University Hospitals. They were allocated into two groups according to the site of injury and surgeon experience; group A included 20 patients who were managed by median sternotomy, and group B included the remaining patients managed by left lateral thoracotomy. All patients were assessed to our center protocol, including primary and secondary surveys, followed by chest x-ray and CT. Then, they were transferred to the operative theater. Operative time, intraoperative blood loss, postoperative ICU and hospital stay, morbidity and mortality rates were compared between the two groups. Our study revealed the following findings: The mean age of the included patients was 35.2 years in group A compared to 34.8 years in group B with no significant difference in statistical analysis. Men formed the majority of the included participants, as they constituted 90% and 80% of patients in the previous two groups, respectively, while the remaining participants were women. Stab wounds were the most common cause of penetrating cardiac injury, as it attributed to 75% and 65% of cases in Groups A and B, respectively. The remaining cases were caused by firearm injury. At admission, heart rate had mean values of 111.75 and 114.75 bpm, whereas systolic blood pressure had mean values of 105 and 99.95 mmHg in the same two groups, respectively. There was no significant difference between the two groups regarding the previous two parameters. The right ventricle was the most common site if injury in both study groups (60% and 50% of patients in Groups A and B respectively), followed by the left ventricle (35% and 45% of patients in the same groups respectively). The right atrium was only affected in one patient in each group (5%).Along with cardiac injury repair, additional procedures included lung repair (15% and 25% of cases in the two groups respectively), great vessel repair (10% and 15% of cases in the same groups respectively), and internal mammary artery ligation (10% of patients in both study groups). Operative time had median values of 185 and 270 minutes in Groups A and B respectively, with a significant prolongation in association with the thoracotomy approach. The same group also showed a significant increase in intraoperative blood loss, and intraoperative blood transfusion (p = 0.003 and 0.004, respectively). The former had median values of 2250 and 3750 ml, while the latter had median values of 1 and 5 units in Groups A and B respectivelyThe duration of mechanical ventilation ranged between one and two days in the two study groups, which was statistically significant between the two groups. The duration of ICU stay had median values of 3 and 5 days in Groups A and B, respectively, with a significant increase in group B. The duration of hospitalization had median values of 5 and 7 days in the same groups, respectively, with a significant increase in group B. Patients in the sternotomy group expressed significantly lower pain scores compared to the thoracotomy group, and that significance persisted till the 7th postoperative day. Wound infection was encountered in 10% and 15% of patients, while pericardial effusion occurred in 15% and 20% of patients in Groups A and B, respectively, with no significant difference between the two groups. Mortality occurred in 15% and 25% of patients in the same groups, respectively, with no significant difference in statistical analysis.