Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres.

Background: For low risk patients undergoing median sternotomies, no midterm follow-up studies involving sternal healing have been conducted. In this study we evaluated sternal healing in low risk patients by chest CT scan and the risk factors associated with poor healing were analyzed.

Methods: Patients who underwent sternal median incision heart surgery from September 2014 to March 2015 were recruited.

Total arch replacement using a 4-branched vascular graft without circulatory arrest.

The technical essentials of the procedure include femoral artery cannulation, selective antegrade cerebral perfusion for brain protection, total arch replacement with a 4-branched vascular graft, implantation of the special open stented graft into the descending aorta, moderate hypothermic balloon occluding descending aorta at 25℃. This technique allows arch reconstruction to be debranched first and upper part of the body is perfused via the 4-branched vascular graft, ensuring antegrade true lumen cerebral perfusion rapidly secured, the descending aorta is arrested by balloon occluding and early rewarming and reperfusion after distal anastomosis to minimize organs ischemia.