Endoscopic repeat sternotomy.

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 mediastinal structures during reoperation. This paper reports a new endoscopic technique to visualize and lyse the adhesions between the sternum and heart prior to repeat median 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 instrumentation. There were 5 patients with prior valve surgery and 19 patients 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 dissection prior to sternal opening.