[Redo sternotomy open heart surgery with cardiopulmonary bypass: challenge and strategy]

Open heart surgery with redo sternotomy is more common recently along with the advanced surgical techniques and better long term patient survival. The mortality can be three times higher than the first time surgery because of the difficulties of re-entry. This article summarizes the experiences of sternal re-entry and mediastinal dissection to decrease the incidence of devastating bleeding, to share all tips and tricks of how to prevent and how to take care of bleeding while doing redo sternotomy and to safely establish cardiopulmonary bypass with all the cannular strategy. An experienced surgical team with preoperative careful planning, meticulous surgical technique, myocardial protection, are critical for optimal outcomes.