Catastrophic hemorrhage on sternal reentry: still a dreaded complication?

Using the reciprocating saw for resternotomy

“…There was no mortality that could be attributed to sternal re-entry, and this low injury rate compares well with the rates found in previously published reports. [1][2][3][4] Morales et al [5] examined 12 retrospective studies and found a 0.5-3.6% incidence of catastrophic hemorrhage. They also noted a discrepancy between the survey findings and published injury rates, which likely reflects the underreporting of resternotomies related to injuries in the literature.…”

“…Another questionnaire showed that a minority of surgeons (153 out of 1,116) would use the reciprocating saw for a resternotomy, but this survey provided no further portrayal of the exact techniques that should be used. [2] The reported higher incidence of injury on sternal re-entry among these surgeons is obviously subject to a much potential bias. Furthermore, these questionnaires notoriously neglected other more important predictors of injury at the time of resternotomies, such as multiple previous resternotomies, a patent internal mammary artery graft, or a history of mediastinal radiotherapy.…”

“…An injury to the heart, great vessels, or previously implanted patent coronary bypass grafts can lead to massive hemorrhage and/or myocardial ischemia and infarction. [1][2][3][4][5] Given these potential risks, many techniques have been described to increase the safety of sternal re-entry. Most of the published reports, however, share a common view that an oscillating saw is preferable to ensure a safe procedure.…”

“…Most of the published reports, however, share a common view that an oscillating saw is preferable to ensure a safe procedure. [1][2][3] The current paradigm gaining widespread acceptance among cardiac surgeons demonizes the use of a reciprocating saw in these cases without producing much supporting evidence. Against this notion, some surgeons have been trained in the use of the reciprocating saw for this type of surgery and continue to use them.…”

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

“…Improved survival of patients with congenital heart disease (CHD) after initial cardiac surgery has resulted in an increase of re-entry sternotomies, a now common procedure that is not associated with increased operative mortality but is associated with an increased risk of postoperative morbidities [6] [7] [8]. While morbidities in this population of patients have not been well defined, ICU LOS is an indicator of morbidity.…”