How to do safe sternal reentry and the risk factors of redo cardiac surgery: a 21-year review with zero major XXXX .

@entity1 @entity548 @entity190 @entity299 @entity439 @entity1167
OBJECTIVES: Resternotomy is a common part of cardiac surgical practice. Associated with resternotomy are the risks of @entity299 and @entity548 and the subsequent elevated morbidity and mortality in the operating room or during the postoperative period. The technique of direct vision resternotomy is safe and has fewer, if any, serious @entity299 . The technique, the reduced need for groin cannulation and the overall low operative mortality and morbidity are the focus of this restrospective analysis. METHODS: The records of 495 @entity1 undergoing 546 resternotomies over a 21-year period to January 2000 were reviewed. All consecutive reoperations by the one surgeon comprised @entity1 over the age of 20 at first resternotomy: M:F 343:203, mean age 57 years (range 20 to 85, median age 60). The mean NYHA grade was 2.3 [with 67 @entity1 (I), 273 (II), 159 (III), 43 (IV), and 4 (V classification)] with elective reoperation in 94.6%. @entity299 was graded into five groups and the incidence and reasons for groin cannulation estimated. The morbidity and mortality as a result of the reoperation and resternotomy were assessed. RESULTS: The hospital/30 day mortality was 2.9% (95% CI: 1.6%-4.4%) (16 deaths) over the 21 years. First (481), second (53), and third (12) resternotomies produced 307 uncomplicated technical reopenings, 203 slower but uncomplicated procedures, 9 minor superficial cardiac lacerations, and no moderate or severe @entity299 . Direct vision resternotomy is crystalized into the principle that only adhesions that are visualized from below are divided and only sternal bone that is freed of adhesions is sewn. Groin exposure was never performed prophylactically for resternotomy. Fourteen @entity1 (2.6%) had such cannulation for aortic dissection/ @entity439 (9 @entity1 ), excessive sternal adherence of cardiac structures (3 @entity1 ), presurgery @entity1167 (1 @entity1 ), and high aortic cannulation desired and not possible (1 @entity1 ). The average postop @entity190 was 594 mL (95% CI:558-631) in the first 12 hours. The need to return to the operating room for control of excessive @entity548 was 2% (11 @entity1 ). Blood transfusion was given in 65% of the resternotomy procedures over the 21 years (mean 854 mL: 95% CI 765-945 mL) and 41% over the last 5 years. CONCLUSIONS: The technique of direct vision resternotomy has been associated with zero moderate or major @entity299 / @entity548 at reoperation. Few @entity1 have required groin cannulation. In the postoperative period, there was acceptable @entity190 , transfusion rates, reduced morbidity, and moderate low mortality for this potentially high risk group.
