Routine presternotomy extracorporeal circulation for redo surgery.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiopulmonary Bypass

Background:

• Resternotomy for cardiac reoperations carries a significant risk of injury to mediastinal structures.
• Presternotomy extracorporeal circulation (ECC) is a strategy employed to mitigate these risks.

Purpose of the Study:

• To evaluate the 10-year clinical experience and outcomes of using presternotomy ECC for cardiac reoperations.
• To assess the safety and efficacy of establishing cardiopulmonary bypass before median sternotomy in reoperative cardiac surgery.

Main Methods:

• A retrospective review of 57 consecutive cardiac reoperations involving resternotomy between January 2006 and December 2015.
• All patients underwent ECC establishment prior to median sternotomy.

Main Results:

• Two patients (3.5%) experienced mortality within 30 days.
• Perioperative morbidity included bleeding requiring reexploration (7.0%), stroke (1.8%), acute renal failure (8.8%), sepsis (8.8%), prolonged ventilation (15.8%), and tracheostomy (8.8%).
• Eleven patients sustained mediastinal structure injuries during dissection, with no injuries reported during sternotomy after ECC establishment.

Conclusions:

• Routine presternotomy ECC effectively reduces the risk of injury to mediastinal structures during resternotomy and facilitates repairs if injuries occur.
• The technique requires longer ECC times and greater transfusion volumes, which necessitate careful management and attention.