Resternotomy using hypothermic arrest.
BACKGROUND
Resternotomy during closed chest cardiopulmonary bypass in hypothermia with or without circulatory arrest has been the preferred method for cardiac reoperations with adherent structures to the sternum. Here, we report our experience with this method and the effects of omitting ventricular decompression during the cooling procedure.


METHODS
Twenty reoperations were performed in 19 patients. In half (n = 10) of the procedures aortic regurgitation was present. Cardiopulmonary bypass was instituted in all patients before resternotomy, and the re-entry into the chest was performed either under hypothermic low-flow cardiopulmonary bypass or circulatory arrest. The reason for this choice of technique was adherent structures to the sternum posing a substantial risk for rupture during resternotomy in all patients.


RESULTS
Rupture upon re-entry into the chest occurred in five operations. No patient died due to re-entry injury. The overall hospital mortality was 15%. No differences in postoperative outcomes including heart failure, biochemical markers indicating myocardial damage, and three-month follow-up assessment of cardiac function were found between patients with aortic regurgitation and patients without aortic regurgitation.


CONCLUSIONS
Based on our experience, omitting ventricular decompression in resternotomy in hypothermia and arrested circulation or low-flow cardiopulmonary bypass can be safely used, and the presence of aortic regurgitation does not seem to influence the outcome.
Möller
Fanny
F
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. fanny.moller@ki.se
Liska
Jan
J
Lockowandt
Ulf
U
Samuelsson
Sten
S
Franco-Cereceda
Anders
A
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency; D015415:Biomarkers; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States
D015415:Biomarkers