[Sternal re-entry using the retractor for harvesting internal thoracic artery]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Techniques

Context:

• Increasing rates of redo cardiac operations, especially coronary artery bypass grafting (CABG), are linked to saphenous vein graft failure.
• Re-opening a median sternotomy poses risks due to potential adhesions between the heart and sternum.
• Preoperative computed tomography aids in assessing cardiac and aortic adhesion severity.

Purpose:

• To present a safe and effective technique for sternal re-entry during redo median sternotomy.
• To describe the use of an internal thoracic artery (ITA) retractor for improved sternal division and adhesion management.

Summary:

• A novel technique utilizes an ITA retractor with attached rake retractors for controlled sternal elevation during re-entry.
• The method involves cutting sternal wires, retracting the sternum, and using an oscillating saw for precise division of the anterior and posterior sternal tables.
• Slight elevation of the left sternum confirms complete division, facilitating dissection of adhesions without additional assistance.

Impact:

• This technique enhances safety and efficiency in redo cardiac surgeries, particularly for patients requiring left ITA harvesting.
• It offers a valuable approach for managing sternal adhesions in any patient undergoing repeat median sternotomy.
• Improved visualization and access reduce the risk of injury during redo sternotomy procedures.