Video-assisted thoracoscopic sternal adhesiolysis before resternotomy reduces morbidity and improves patient care.

Background: Resternotomy still carries an important risk for an already high-risk population. Re-entry injuries may lead to massive bleeding, which can be difficult to control due to poor accessibility. The aim of the study was to assess early outcomes of video-assisted thoracoscopic adhesiolysis, as well as safety and feasibility.

Methods: Forty-five patients received a video-assisted thoracoscopic adhesiolysis before resternotomy between April 1, 2016 and January 1, 2019. Records were reviewed for demographics, perioperative and early postoperative (Postop) outcomes.

Results: The median age of the population was 73 years with a EUROSCORE II of 8.322. Only 1 (2.22%) patient experienced a major and 2 (4.44%) a minor re-entry injury. This resulted in a mean peroperative and 24-hour Postop blood loss of, respectively, 675.72 (range: 5-2862) and 444.71 mL (range: 0-2100). There was no significant difference between the use of minimally invasive and classic extracorporeal circulation (P = .276 and P = .81, respectively). Twenty-nine patients (64%) were not in need of red blood cell transfusion. A survival rate of 93.33% could be achieved. No deaths (n = 3) were related to the video-assisted thoracoscopic adhesiolysis or re-entry injuries. Kidney function remained stale postoperatively with creatinine preoperative and Postop levels of 1.56 (95%confidence interval: 1.07-2.05) and 1.43 (95%CI, 1.05-1.81) mg/dL (P = .264). Despite high-risk surgery, the median length of stay was 8 days.

Conclusion: A video-assisted thoracoscopic approach allows for a safe and effective adhesiolysis, due to increased visibility and accuracy. This approach may prevent major and minor re-entry injuries and consequently reduce perioperative morbidity and mortality of high-risk surgery.