Reentry to the Mediastinum When the Ascending Aorta Is Adherent to the Sternum: A Two-Stage Sternotomy Approach

Reentry to the mediastinum when the ascending aorta aneurysm is adherent to the sternum is characterized by high risk of aneurysm rupture during sternum opening. In such cases, often cardiopulmonary bypass via peripheral vessels is instituted, and reentry done in deep hypothermia and circulatory arrest. To reduce both risks of aneurysm rupture during resternotomy and those related to prolonged cardiopulmonary bypass time, we present a surgical approach consisting of a two-stage sternotomy to avoid the risky zone and extra-anatomic epiaortic vessels anastomoses.