title: [Safety of repeat median sternotomy in the palliative treatment of patients with a univentricular heart].
abstract: OBJECTIVE
  To establish the morbidity and mortality of patients with univentricular hearts who underwent a repeat median sternotomy at the Instituto Nacional de Pediatría.
  
  
  METHODS
  A retrospective review was performed on the clinical charts of all patients who underwent a repeat median sternotomy from 2001 to 2016.
  
  
  RESULTS
  Sixty-five patients underwent 76 surgeries by repeat median sternotomy. Fifty-nine patients had a first repeat median sternotomy, with a mean age of 36 months (range: 4-176 months) and a mean weight of 12.2 kg (range: 3.2-21.5 kg). Forty patients had a Glenn procedure, and 19 patients had a Fontan procedure. There were 17 patients with a second repeat median sternotomy, with a mean age of 89 months (range 48-156 months), and a mean weight of 22.7 kg (14.4-41 kg). A Fontan procedure was performed on all these 17 patients. A section of the right coronary artery with electrocardiographic changes and a right atrium tear that caused hypotension occurred during first repeat sternotomy. An aortic tear occurred during a second repeat sternotomy with massive bleeding and subsequent death. This represents 3.9% of re-entry injuries.
  
  
  CONCLUSIONS
  It is concluded that repeat median sternotomy is a safe procedure.
authors.affiliation: Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: Héctor
authors.initials: H
authors.lastname: Díliz-Nava
authors.affiliation: Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: Isis
authors.initials: I
authors.lastname: Meléndez-Sagaón
authors.affiliation: Anestesiología Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: Orlando
authors.initials: O
authors.lastname: Tamaríz-Cruz
authors.affiliation: Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: Luis
authors.initials: L
authors.lastname: García-Benítez
authors.affiliation: Terapia Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: Aric
authors.initials: A
authors.lastname: Araujo-Martínez
authors.affiliation: Cirugía Cardiovascular, Instituto Nacional de Pediatría, Ciudad de México, México. Electronic address: apalaciosmacedo@icloud.com.
authors.forename: Alexis
authors.initials: A
authors.lastname: Palacios-Macedo
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*
keywords: Corazón univentricular; Fontan; Glenn; Mexico; México; Re-esternotomía media; Repeat median sternotomy; Safety; Seguridad; Univentricular heart