An Introduction to Redo Sternotomy 

Beautiful, instructive video that clearly show your masterful technique. A simple but superb contribution . I would like to add 5 possibly helpful additions: 1. I usually like to leave the front of the wires transected and keep the backs intact. By pulling up on both sides of the transected front wire with clamps you can elevate the sternum, and the back wire may prevent you from using the micro sagittal saw too deeply. When you go past the wire, you can then remove it. 2. Sometimes a Gelpi/ spine type retractor or a pediatric chest spreader can be gently placed into the sternal edges as you move cephalad and can help separate the sternal halves. 3. If the adhesions aren't too dense, it may be preferable to widely enter both pleural spaces to safely place the chest retractor and drop the mediastinum 4.I have found that using a heavy straight scissor can sometimes be safer to divide the posterior tissues as opposed to the saw. 5. You mentioned grafts crossing the midline or aorta stuck to the sternum. What I have done in several such cases was ask my thoracic surgical colleague to do a thoracoscopic approach starting out laterally. Under superb visualization, they were able to quickly and safely dissect off the structures, and then easy sternotomy followed. Thank you so much Dr Gaudiani for taking the time and effort to educate us all in your many beautiful demonstrations and techniques.

Thx for your note. All solid ideas. Reoperation is intensely personal. I never leave wires because I can sense the back table with the narrow blade. I always have good help so I like handheld retractors. I frequently get into both thoraces. So the key is to know what works in your own hands. As you recognized, this video is just a preliminary sniff at the world of redos that take a lifetime to master. Thanks again. Vince