Life-saving Cannulation Strategies in High-risk Resternotomy for Pediatric Patients: A Single-center Experience

Abstract

Aim: Despite advances in surgical experience and imaging techniques, resternotomy (RS) in pediatrics remains a high-risk procedure due to its potential for heart and major vessel injuries. This study aims to retrospectively evaluate RS cases in our clinic, focusing on high-risk patients and examining the effectiveness of various cannulation techniques. Methods: This retrospective study,included pediatric patients under 18 years of age who underwent RS between August 2019 and December 2023. Exclusion criteria included intervals of less than 30 days between consecutive RS procedures. Patient demographics, diagnoses, and RS-related outcomes were extracted from medical records. High-risk factors for major cardiac and vascular injury during RS were identified, and patients were categorized accordingly. Major injuries and outcomes of the various cannulation techniques were analyzed. Results:Out of 1,718 sternotomies, 157 (9.1%) were RS procedures, with 33 patients (21%) classified as high-risk. Major cardiac and vascular injuries occurred in 7 patients (4.5%), and RS-related mortality was recorded in 2 cases (1.2%). For high-risk patients, the femoral artery and vein were commonly prepared for emergent or elective cannulation, with alternative strategies employed when femoral vessels were unsuitable for cannulation. Three patients undergoing carotid artery cannulation showed no signs of neurological complications, supporting its viability as an alternative strategy in pediatric high-risk RS. Conclusion: Resternotomy remains a challenging procedure with substantial risk for major bleeding, especially in high-risk cases. For complex cases, preparation for alternative cannulation methods remains crucial to manage unexpected complications effectively.

Keywords

• Pediatrics
• resternotomy
• cannulation

References

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