An approach to reoperative median sternotomy

Cardiac reoperations using a previous median sternotomy incision are becoming more common as the population of patients who have had cardiac surgery increases. Repeat median sternotomy can be complicated by major hemorrhage and secondary myocardial ischemia. A standard approach to reoperative median sternotomy has been developed over the past several years at Georgetown University. Details of the method are presented. From January 1, 1980 through April 30, 1988, 179 patients underwent repeat median sternotomy. The technical approach to the operation became standard as of July 1,1983. Two of 66 patients operated before this date sustained major hemorrhage requiring emergent institution of cardiopulmonary bypass. One mortality in the group was directly related to hemorrhage at the sternotomy. No episode of major hemorrhage and no mortality related to the sternotomy occurred in 113 patients who underwent repeat sternotomy after July 1, 1983. Reoperation for bleeding occurred in 8.4% of the patients. We believe the technical considerations presented increase the safety of reoperative cardiac surgery.