Repeat median sternotomy for the automatic implantable cardioverter and defibrillator.

Forty-four patients with a repeat sternotomy for the implantation of the automatic implantable cardioverter and defibrillator are presented. Thirty-three of the patients had placement of the device only and 11 had a concomitant open heart procedure--nine for aorto-coronary bypass (mean of 1.6) and two for mitral valve replacement. Twenty-two complications occurred in 17 patients. Arrhythmia was the most common problem. Two deaths occurred perioperatively in the group (mortality rate of 4.5 per cent) and were caused by gram-negative pneumonia and pulmonary embolus. There were no specific complications related to the sternotomy. It is, therefore, concluded that the repeated sternotomy is an excellent method to insert the automatic cardioverter and defibrillator.