Direct complications of sternal re-entry.

摘要

This is in reference to the article titled "Direct Complications of Repeat Median Sternotomy in Adults" by Mr Elahi et al.I notice that they have dealt with various aspects of the direct complications and the value of femoro-femoral bypass in those situations. I wanted to add few points to them2 and ask the author if he has any experience in those situations. First of all, as Mr Elahi mentioned, hemostasis is vital in sternal re-entry. So, as a routine factor, we use Aprotinin (Trasylol; Bayer AG, Germany) in half Hammersmith dose in all patients (1 million KI unit during induction of anesthesia and a further 1 million KI unit during initiation of CPB) with ACT maintained at least 700 during CPB. The incidence of bleeding complications and coagulopathy were noticed much less with this protocol. Certain dissection manoeuvres were quite useful especially in reentry situations. All patients had their groin electively prepared and kept ready for access if needed. We had to use only once for an emergency femoral arterial access for establishing CPB in an inadvertent right