Abstract
Resternotomy and reoperations to treat the sequelae and residua for congenital heart disease in the adult are associated with multiple challenges of intraoperative hemodynamic management, selective peripheral cannulation, safe reentry, and careful cardiac dissection. Resternotomy is a marker of operative mortality that increases with each successive mediastinal entry. Unwanted cavitary entry during sternal reentry can cause significant hemodynamic instability, especially in patients with prior Fontan operations. Any unexpected decrease in right atrial pressure owing to uncontrolled hemorrhage results in hypovolemic consequences that unfavorably impact the driving force (elevated central venous pressure) that controls the pulmonary circulation and cardiac output. These same sets of circumstances also negatively impact patients who are undergoing ventricular-to-pulmonary conduit replacement, reoperations for tetralogy of Fallot, and tricuspid valve repairs, among others. There are numerous methods of resternotomy. In this chapter, we offer some techniques that have been associated with excellent results and a minimal rate of unwanted cavitary reentry in our collective experience.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsAbbreviations
- PTFE:
-
Polytetrafluoroethylene
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Figure Credits
Figure Credits
-
Figs. 1.13 and 1.14: Reproduced with permission from Mayo Foundation for Medical Education and Research.
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Mavroudis, C., Dearani, J.A. (2020). Resternotomy and Peripheral Cannulation. In: Mavroudis, C., Dearani, J. (eds) Atlas of Adult Congenital Heart Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-14163-9_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-14163-9_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-14162-2
Online ISBN: 978-3-030-14163-9
eBook Packages: MedicineMedicine (R0)