[Re-sternotomy]

The indications and techniques for an pitfalls to avoid which might result in complications after resternotomy are reviewed. The relationship between anterio mediastinal structures and the posterior aspect of the sternum (as visualized on chest, films, CT, or tomography), and other approach(es) including the pros and cons of the contemplated procedure must be assessed carefully. Preparations for emergency F-F cardiopulmonary bypass must be completed before resternotomy. The Wires of the previous operation are undone, but kept in place as safeguards during sternal division using an oscillating (not reciprocating) bone saw. After their removal, the pericardium or other mediastinal structures adhering to the posterior aspect of the sternum are freed before applying a small sternal retractor. The pericardial dissection plane is developed at the cardiophrenic angle, advanced cephalad and laterally on the surface of the right ventricle and atrium. Cephalad dissection starts with imnominate vein identification down the superior vent cave, keeping in mind the location of the right phyenic nerve, and toward the anterior aspect of the great vessels. Repairing small ventricular or aerial lacerations should not be attempted before releasing the tension by sharp dissection of the adhesions surrounding the laceration, and repair of great vessel injuries is best done under cardiopulmonary bypass.