Endoscopic Repeat Sternotomy

Abstract

Background: Repeat cardiac surgery represents eight to twenty five percent of cardiac surgical procedures. Catastrophic hemorrhage is a known complication of repeat sternotomy. A number of techniques have been described to reduce the incidence of injury to the heart and medi-astinal structures during reoperation. This paper reports a new endoscopic technique to visualize and lyse the adhesions between the sternum and heart prior to repeat medi-an sternotomy.

Methods: A unique substernal retractor and endoscopic visualization system was developed specifically to facilitate safe and rapid sternotomy in reoperative cardiac cases. Twenty-four patients underwent elective reoperation using the Endoscopic Redo Sternotomy Retractor® and instrumen-tation. There were 5 patients with prior valve surgery and 19 with coronary bypass grafts in place. Retrosternal adhesions were divided with special endoscopic cautery or scissors after which a standard reciprocating saw was used to open the sternum without damage to underlying structures.

Results: The time required for endoscopic dissection of retrosternal adhesions ranged from 6 to 22 minutes. No injury to any cardiac structure or conduit occurred.

Conclusions: The Endoscopic Redo Sternotomy Retractor® provides excellent visualization of all retrosternal structures and adhesions allowing safe and meticulous dis-section prior to sternal opening.