Repeat median sternotomy in pediatrics: experience in 164 consecutive cases

Area of Science:

• Pediatric Cardiac Surgery
• Thoracic Surgery
• Cardiovascular Surgery

Background:

• Repeat median sternotomy is often necessary for reoperations in pediatric cardiac surgery.
• Challenges include increased risk of adhesions and potential injury during sternal reentry.

Purpose of the Study:

• To evaluate the safety and efficacy of a specific technique for repeat median sternotomy in children.
• To compare outcomes between initial and repeat sternotomy procedures.

Main Methods:

• A cohort of 138 children underwent 164 repeat median sternotomies.
• The technique involved careful sternal opening, blunt dissection, avoidance of electrocautery for adhesions, and judicious use of blood products.
• Variables analyzed included time to bypass, bleeding, and operative injuries.

Main Results:

• Repeat sternotomy took approximately one hour longer than initial procedures (174 vs. 96 minutes).
• Operative transfusions and postoperative bleeding were not significantly different between initial and repeat sternotomies.
• Eight injuries (5%) occurred during reoperation, with no deaths directly related to the technique.

Conclusions:

• The described technique for repeat median sternotomy in children is safe and effective.
• It provides a valuable alternative for managing pediatric cardiac surgery reoperations with acceptable complication rates.