Video-assisted thoracoscopic redo sternotomy for primary dysfunction of the aortic root homograft: a case report

Adhesion in the anterior mediastinum following previous heart surgeries is a predictor of fatal trauma of the heart chambers, large vessels and lungs during redo cardiac procedures. The approaches used to prevent such complications have evolved over the past decades, but the need for their improvement remains. Annual increase in heart surgeries, coupled with the phenomenon of "aging population" in economically developed countries, predetermines the growth of redo cardiac surgical procedures. An important role in this process is also played by the recent more active use of various biological implants (for example, bioprosthetic heart valves), which makes the search for new technologies for safe redo sternotomy even more urgent. The publication presents a case of redo surgery in a patient with primary degeneration of the homograft in the aortic root position implanted 13 years ago for aortic stenosis using the Full Root technique. The original technique applied (Method for endoscopic prevention of traumatisation of cardiac, lung and major vessels of anterior mediastenum accompanying repeated cardiosurgical operations. Patent No. RU 2726605 C1) provides for a combination of minimally invasive and classic surgical approaches. Total adhesiolysis of the anterior mediastinum was performed thoracoscopically: the posterior surface of the sternum and the cartilaginous part of the ribs were completely freed from adhesions with the right ventricle, the aorta, lungs and innominate vein. The redo sternotomy was made using a standard electric saw under direct visual control and protection of the right ventricle and the ascending aorta with endoscopic retractors. The risk of surgical trauma of the anterior mediastinum organs was fully eliminated and the intraoperative blood loss was comparable to a traditional sternotomy approach.