Routine Presternotomy Extracorporeal Circulation for Redo Surgery

Nagoya J Med Sci. 2019 Nov;81(4):549-555

Routine establishment of presternotomy ECC reduces the risk of injury to the mediastinal structures during reentry and facilitates easier repair in the event of structural injury during reentry or dissection.

To reduce the risk of adverse events, presternotomy extracorporeal circulation (ECC) is routinely performed at our institution for patients who require resternotomy. We report our 10-year experience of performing presternotomy ECC for cardiac reoperation and the clinical results. Fifty-seven consecutive cardiac reoperations involving resternotomy were performed between January 2006 and December 2015. ECC was established prior to median sternotomy in all patients. Two patients sustained injury to the right ventricle during sternotomy. Eleven patients sustained injury to the mediastinal structures during dissection (right atrium in 3; superior vena cava in 2; inferior vena cava in 3; left internal thoracic artery in 1; and saphenous vein graft in 2 patients). Longer ECC time and greater transfusion volume were necessary. Two patients (3.5%) died within 30 days of operation. Perioperative morbidity included reexploration for bleeding in 4 (7.0%), stroke in 1 (1.8%), acute renal failure that required hemodialysis in 5 (8.8%), sepsis in 5 patients (8.8%), prolonged ventilation in 9 (15.8%) and tracheostomy in 5 (8.8%). Routine establishment of presternotomy ECC reduces the risk of injury to the mediastinal structures during reentry and facilitates easier repair in the event of structural injury during reentry or dissection. However, longer ECC time and significantly greater transfusion volume requires attention.