Extracorporeal circulation by peripheral cannulation before redo sternotomy: Indications and results

Objectives

Cardiac reoperations are challenging and time-consuming, and have a high risk for reentry injuries. We discuss the indications, advantages, and technologic features of cardiopulmonary bypass by peripheral cannulation before resternotomy.

Methods

Of 610 redo cardiac interventions from 2000 to 2006, 158 (25.9%) were performed with peripheral cannulation and ongoing cardiopulmonary bypass before resternotomy. This was indicated in the following: close adhesions between the sternum and the anterior cardiac surface; ascending aorta or bypass grafts (computed tomography scan); and patients with functional tricuspid regurgitation, hemodynamic/electric instability, previous mediastinitis, or depressed ejection fraction. Intraoperative transesophageal echocardiography was always performed.

Results

Venous drainage was obtained by cannulation of the common femoral vein (Seldinger technique) and right internal jugular vein (percutaneously). Arterial nonocclusive cannula was placed in the femoral artery (Seldinger technique). Cardiopulmonary bypass time before cardiotomy was 35 ± 14.7 minutes. There were 5 perioperative deaths, none due to reentry injury. Damage to mediastinal structures at resternotomy occurred in 4 cases. In all cases, peripheral cardiopulmonary bypass allowed adequate and comfortable repair. The operative time was 296 ± 60 minutes. The average total postoperative bleeding was 264 ± 38 mL/m². No patient experienced complications related to femoral cannulation. The Seldinger method allowed little vascular trauma and intraoperative patency of femoral vessels.

Conclusion

In selected patients, cardiopulmonary bypass before resternotomy is a valid and reproducible option to render cardiac reoperations safer and more expeditious in the reentry phase. The absence of cannulae in the operating field makes the procedure more comfortable. The liberal use of this strategy is recommended in redo cases.

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, CT, computed tomography

CTSNet classification: 18, 25