Repeat median sternotomy in pediatrics: experience in 164 consecutive cases

Abstract

One hundred thirty-eight children underwent 164 operations through repeat median sternotomy. Ages ranged from 4 months to 21 years (mean, 8.6 +/- 5.0 years). The technique consisted of opening the sternum with chisel and mallet, avoidance of sudden separation of sternal edges and blunt dissection, elimination of the electrocautery during lysis of adhesions, and judicious use of fresh blood and components. Several variables were analyzed comparing the initial and repeat procedures on each patient. Time from incision to bypass was an hour longer with the repeat procedure (174 +/- 45 minutes versus 96 +/- 37 minutes). Operative transfusions and postoperative bleeding (first 48 hours) were not significantly different between the two procedures. Cyanosis, however, significantly increased bleeding in both groups. There were eight injuries (5%) at reoperation. During sternal reentry in 2 patients, a tear occurred in a valved conduit coursing underneath the sternum. A right ventricular tear occurred in 1 patient while the sternal edges were being separated. Ventricular fibrillation was noted in 2 patients during lysis of adhesions with the electrocautery used early in the series. Intimal disruption occurred in two valved conduits during intraoperative manipulations. An aortic tear occurred and was repaired without cardiopulmonary bypass. There were 13 (8%) hospital deaths, all unrelated to the technique. We believe that the current approach can be a valuable alternative for surgeons dealing with repeat median sternotomy in children.