Minimally Invasive Toally Thoracoscopic Adhesiolysis: The Novel Strategy For Safe Sternotomy In Redo Cardiac Surgery
Egor Malyshenko, Vadim Popov, Maxim Novikov, Magomed Gasangusenov, Semen Petko, Amiran Revishvili.
A.V. Vishnevskiy National research center of surgery, Moscow, Russian Federation.
BACKGROUND:The formation of an adhesions in the anterior mediastinum after previous cardiac surgeries is a predictor of fatal trauma of the right heart chambers, great vessels and lungs during redo cardiac cases. The improvement of surgical techniques to reduce the risk of significant complications during redo cardiac surgery is critically important.
METHODS:12 totally endoscopic video-assisted cases with retrosternal adhesiolysis before the resternotomy were performed from 2018 to December 2022 in our center. We placed three 5mm ports in the third and the fifth intercostal spaces in the midclavicular line and in the fourth intercostal space in the Linea axilaris anterior. The dissection of adhesions was made from jugular notch to xiphoid. After the release of the sternum the metal wires were removed under direct vision control with 5mm 0̊ optic. The sternotomy was performed with standard sternal saw also under direct vision control using endoscopic retractors (Fig.1) for protecting the heart and great vessels.RESULTS:All redo cases were successfully performed - 2 aortic root prosthesis replacement, 4 AVR, 5 MV repair and 1 CABG after aortic root replacement with endoscopic video-assisted retrosternal adhesiolysis. Mean time of adhesiolysis was 42,5±6,2 min , extent of blood loss was 39,6±4,2. There was no trauma of the main vessels, heart chambers or lungs. Extracorporeal circulation was not required during the sternotomy. There was no mortality in our study. CONCLUSIONS:Minimally invasive totally thoracoscopic adhesiolysis is a safe and effective strategy to avoid catastrophic complication of redo cardiac cases. 
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