Redo Cardiac Surgery Using Vasoview System To Facilitate Sternal Entry
BAYAN alshaikh1, Walid Abukhudair1, Abdulkarim Abukhodair2, khalid alsheaty1.
1KFAFH, jeddah, Saudi Arabia, 2king saud university, jeddah, Saudi Arabia.
OBJECTIVE: The aim of our study is to evaluate outcomes of redo cardiac surgery using the endoscopic vaso-view system to facilitate sternal re-entry . METHODS:Between May 2016 until june 2018, a total of 29 patients underwent redo cardiac surgery using the endoscopic vaso-view system introducing the blunt dissector through a small sub-sternal incision which facilitate blunt dissection of adhesions underneath the sternum making a space between the sternum and the heart under vision then followed by a sternotomy with an oscilliating saw .All patients had preoperative ct scan . RESULTS: A total of 29 patients were identified procedure performed were 82% valvular surgery and 18 % CABG at King Fahad Armed Forces Hospital (KFAFH). 24% were second redo and 76% were first redo . patients characteristics The mean age was 55 ± 32 years , 65% were females , 45% were males and mean LVEF was 50%± 30% with an average EuroSCORE II was 4.8 ± 1.6 . Intra-operatively patients had femoral cannulation 20.6% , central cannulation in 71% and off pump in 3.4% while mean bypass time was 125± 20 min , cross clamp time 111±10 min 6.8% had RV injury . Overall in-hospital mortality was 3.5 % , mean ICU stay 5 ± 3 days (d) and length of stay (LOS) 16±10 d . No re-operation for bleeding , mean blood loss in first 24h 474± 230 ML , number of blood products used intraoperative was 1.4±1 units and postoperatively 1.5±1 units , Stroke rate was 6.8% , Afib 38%, MI 3.5 % ,no renal failure requiring dialysis and 13.7 % had prolonged ventilation . CONCLUSIONS: Redo cardiac surgery using the endoscopic vase view system to facilitate sternal re-entry showed that it is a safe and effective approach in our hands to clear adhesions under vision facilitating sternal re-entry . A comparative study will be our next step to validate our conclusion and encourage surgeon to adopt this approach .
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