Safe sternal reentry in patients with large thoracic aortic pseudoaneurysms

Safe sternal reentry in all age groups with the Rultract Resternotomy Retractor™

In patients undergoing repeat sternotomy, the risk of injury to cardiac structures can be reduced by utilizing a technique that provides sustained visualization of structures adherent to underside of the sternum. We discuss the use of a retractor specifically designed for this purpose: the Rultract Resternotomy Retractor™.

Resternotomy, a single-center experience

Background Reoperations are technically more difficult because of the risks associated with reentry in a heart with more advanced pathology, little reserve, and more frequent comorbidities. Routine peripheral cannulation before resternotomy is inadvisable, time-consuming, and has no noticeable role in decreasing the risks of reentry. We present our experience of resternotomy without routine peripheral cannulation. Methods This was a retrospective study on 237 consecutive patients who underwent resternotomy between June 2011 and July 2013. Their mean age was 47.7 ± 18.2 years. We chose the best approach individually, according to lateral radiograph findings, patient risk factors, and previous surgery. Our goal was to observe events intraoperatively and their outcomes postoperatively. Results Mean intensive care unit stay was 3.1 ± 0.9 days. Twenty-one (8.8%) patients died during their hospital stay. The most common cause of death was renal failure in 15 (71.4%) patients, coagulopathy in 4 (19%), and cardiac failure in 2 (9.5%). We had 3 right ventricular, one right atrial, one pulmonary artery, and 2 inferior vena caval tears during resternotomy and dissection; bleeding was controlled easily without peripheral cannulation. Femoral cannulation before resternotomy was performed in one patient who needed an emergency pulmonary embolectomy. Conclusions Based on our experience, resternotomy with central cannulation is a safe strategy, and peripheral cannulation before resternotomy should be reserved for highly selected patients.