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Establishment of Deep Hypothermic Circulatory Arrest in Rats
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Resternotomy using hypothermic arrest.

Fanny Möller1, Jan Liska, Ulf Lockowandt

  • 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. fanny.moller@ki.se

Journal of Cardiac Surgery
|March 6, 2010
PubMed
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Omitting ventricular decompression during cardiac reoperation resternotomy is safe, even with aortic regurgitation. This technique minimizes risks associated with sternal adhesions during hypothermic cardiopulmonary bypass.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Anesthesia

Background:

  • Cardiac reoperations with sternal adhesions often require resternotomy.
  • Hypothermic cardiopulmonary bypass (CPB) with or without circulatory arrest is a common approach.
  • The safety and impact of omitting ventricular decompression during cooling are not well-established.

Purpose of the Study:

  • To evaluate the safety and outcomes of omitting ventricular decompression during resternotomy in cardiac reoperations.
  • To assess the influence of aortic regurgitation on outcomes in this patient cohort.

Main Methods:

  • Twenty reoperations were performed in 19 patients.
  • CPB was initiated before resternotomy, using hypothermia with low-flow CPB or circulatory arrest.

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  • Ventricular decompression was omitted in all cases.

    • Main Results:

    • Rupture upon re-entry occurred in 5 operations; no deaths resulted from this injury.
    • Overall hospital mortality was 15%.
    • No significant differences in postoperative outcomes or cardiac function were observed between patients with and without aortic regurgitation.

    Conclusions:

    • Omitting ventricular decompression during resternotomy in hypothermic CPB is a safe technique.
    • The presence of aortic regurgitation does not appear to negatively impact outcomes in this setting.