Reoperative sternotomy

The success of modern cardiac surgery can be measured to some degree by the frequency with which we see patients return for reoperative procedures either to address new disease or degeneration and late failure of previously placed prostheses. Accordingly, safe conduct of reoperative sternotomy is a fundamental skill that must be mastered by all cardiac surgeons. It is rife with potential complications and potential catastrophic consequences. Accordingly the cardiac surgeon must be familiar with both the complications and their management. In this case, during a reoperative sternotomy the innominate vein is torn requiring the emergent institution of cardiopulmonary bypass. The vein is repaired with a pericardial patch before proceeding with the operation. The value of preoperative axial imaging and prophylactic cannulation of the femoral vessels is discussed.