Two-Stage Sternotomy Approach to Hostile Chest Reentry for Orthotopic Heart Transplantation

Background: Repeat cardiac operations carry increased risk of morbidity and mortality due to adhesions between the heart and adjacent structures, which increase the complexity of redo sternotomy and the potential for reentry injury. Preoperative CT imaging has been associated with a decreased risk for reentry injury. Methods: We present a series of two cases of complex thorax reentry in which a stepwise sternotomy approach enabled safe reentry. Results: Both patients tolerated the procedure well, with successful orthotopic heart transplantation in each case. A thorough review of the preoperative CT imaging enabled surgical planning to safely navigate structures at high risk for reentry injury. Conclusions: This series demonstrates the utility of two-stage sternotomy in complex thorax reentry cases and the importance of preoperative imaging for the safe surgical planning of such an approach.