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Eur J Cardiothorac Surg 2002;21:932-934
© 2002 Elsevier Science NL

How-to-do-it

Video assisted resternotomy in high-risk redo operations — the St Mary's experience

Department of Cardiothoracic Surgery, St Mary's Hospital, London, UK

Received 5 December 2001; received in revised form 29 January 2002; accepted 31 January 2002.

* Corresponding author. 70 St Olaf's Road, London SW6 7DN, UK. Fax: +44-207-886-1147
e-mail: tathan5253{at}aol.com

The incidence of re-operative median sternotomy is rising. During resternotomy, catastrophic haemorrhage remains a dreaded complication. We describe our approach and experience with the combined use of Mayfield resternotomy retractor and anterior sternal retraction which allows division of adhesions between the sternum and mediastinal structures under direct vision with endoscopic or conventional instruments prior to resternotomy with a standard Hall reciprocating saw. The mean time to divide the retro-sternal adhesions was 26.4±16.7 min. No morbidity related to sternal division was observed. For redo surgery, repeat sternotomy under direct vision may reduce the sternotomy related morbidity (especially the need for cardiopulmonany bypass due to significant haemorrhage) and mortality.

Key Words: Redo cardiac surgery • Endoscopic resternotomy • Video assisted resternotomy

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