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

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.