A Novel And Safer Approach To Redo Sternotomy In Patients With Complex Congenital Heart Disease
Ali Ibrahimiye, Nicholas Bullington, Camille Hancock Friesen.
Childrens hospital and Medical Center Omaha, Omaha, NE, USA.
Objective(s): Repeat sternotomy for redo cardiac surgery may be associated with catastrophic injuries to mediastinal structures. The incidence of re-entry injury is low; however it is associated with a significant increase in the risk of in hospital mortality. The purpose of this study was to introduce a novel technique for redo sternotomy.
Methods: Between October 2021 and May 2022, 26 patients underwent redo sternotomy in our institution using the Misonix BoneScalpel R. Patients age ranged from 4 months to 18 years. There were 2nd (n=9), 3rd (n=12) and 4th ( n=5) time sternotomies in the group. The Misonix BoneScalpel R has an ultrasonically vibrating blade that compresses the bone through repetitive impacts at 22,500 times per second cleaving its way into the bone and cutting it. Its unique mechanism of action allows it to cut only bone but not soft tissue including myocardium, lung or blood vessels.
Results: There were no reentry injuries. No patients were placed on bypass or ECMO preemptively or prior to fully opening the sternum. No patients required blood transfusion due to blood loss from the sternotomy.
Conclusions: Misonix BoneScalpel R is a new tool that utilizes novel supersonic technology. This unique mechanism of action allows the surgeon to be very accurate and safe since the physics of the device doesn't allow it to cut any soft tissue. We believe this is a safe technique to perform redo sternotomy especially in challenging multiple redo's where the cost of any reentry injury can be very high.
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