Acta Scientific Cardiovascular System

Review Article Volume 1 Issue 7

Video-assisted Thoracoscopic Redo Sternotomy for Primary Dysfunction of the Aortic Root Homograft: A Case Report

ES Malyshenko1*, SA Petko2, VA Popov1, MG Gasangusenov1 and A Sh Revishvili1

1A.V. Vishnevsky National Medical Research Center for Surgery, Moscow, Russian Federation, Russia
2Federal State Autonomous Educational Institution of Higher Education “Peoples' Friendship University of Russia”, Moscow, Russian Federation, Russia

*Corresponding Author: ES Malyshenko, A.V. Vishnevsky National Medical Research Center for Surgery, Moscow, Russian Federation, Russia.

Received: November 01, 2022; Published: November 30, 2022



Adhesion in the anterior mediastinum following previous heart surgeries is a predictor of fatal trauma of the heart chambers, large vessels and lungs during redo cardiac procedures. The approaches used to prevent such complications have evolved over the past decades, but the need for their improvement remains. Annual increase in heart surgeries, coupled with the phenomenon of “aging population” in economically developed countries, predetermines the growth of redo cardiac surgical procedures. An important role in this process is also played by the recent more active use of various biological implants (for example, bioprosthetic heart valves), which makes the search for new technologies for safe redo sternotomy even more urgent.

The publication presents a case of redo surgery in a patient with primary degeneration of the homograft in the aortic root position implanted 13 years ago for aortic stenosis using the Full Root technique. The original technique applied (Method for endoscopic prevention of traumatisation of cardiac, lung and major vessels of anterior mediastinum accompanying repeated cardiosurgical operations. Patent No. RU 2726605 C1) provides for a combination of minimally invasive and classic surgical approaches. Total adhesiolysis of the anterior mediastinum was performed thoracoscopically: the posterior surface of the sternum and the cartilaginous part of the ribs were completely freed from adhesions with the right ventricle, the aorta, lungs and innominate vein. The redo sternotomy was made using a standard electric saw under direct visual control and protection of the right ventricle and the ascending aorta with endoscopic retractors. The risk of surgical trauma of the anterior mediastinum organs was fully eliminated and the intraoperative blood loss was comparable to a traditional sternotomy approach.

Keywords: Allografts; Aortic Valve Stenosis; Bioprosthesis; Case Reports; Heart Valves; Mediastinum; Sternotomy; Thoracic Surgery; Video-Assisted



  1. Kindzelski BA., et al. “Modern practice and outcomes of reoperative cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery (2021): S0022-5223 (21)00125-2.
  2. Machiraju VR. “Problems related to redo cardiac surgery”. In: Machiraju V., Schaff H., Svensson L., editors. Redo cardiac surgery in adults. New York: Springer (2012): 1-6.
  3. Temeck BK., et al. “An approach to reoperative median sternotomy”. Journal of Cardiac Surgery 1 (1990): 14-25.
  4. Agarwal S., et al. “The incidence and effect of resternotomy following cardiac surgery on morbidity and mortality: a 1-year national audit on behalf of the Association of Cardiothoracic Anaesthesia and Critical Care”. Anaesthesia1 (2021): 19-26.
  5. Keren MA and Kazaryan AV. “Recurrent ischemia after open myocardial revascularization: current state of the problem, risk factors, prognosis, tactics and results of repeated interventions”. Annals of Surgery 5 (2017): 257-264.
  6. Skopin II., et al. “Redo aortic root operations in late prosthetic endocarditis: clinical case series”. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery4 (2019): 73-83.
  7. Awad WI., et al. “Re-do cardiac surgery in patients over 70 years old”. European Journal of Cardiothoracic Surgery1 (1997): 40-46.
  8. François K., et al. “Repeat aortic valve surgery: contemporary outcomes and risk stratification”. Interactive CardioVascular and Thoracic Surgery (ICVTS) 2 (2021): 213-221.
  9. Greason KL and Schaff HV. “Reoperation for prosthetic mitral valve endocarditis”. In: Machiraju V., Schaff H., Svensson L., editors. Redo cardiac surgery in adults. New York: Springer (2012): 99108.
  10. Ismail I., et al. “Retrosternal adhesiolysis through an anterior minithoracotomy: a novel approach facilitating complete median redo sternotomy with a patent internal thoracic artery graft”. The Journal of Thoracic and Cardiovascular Surgery 4 (2009): 1034-1035.
  11. Gordeev ML., et al. “Analysis of direct results of reoperative coronary artery bypass surgery”. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery1 (2021): 85-96.
  12. Sigaev IYu and Kazaryan AV. “Operational access during redo coronary artery bypass grafting. The Bulletin of Bakoulev Center”. Cardiovascular Diseases22 (2022): 130-138.
  13. Luciani N., et al. “Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results”. The Journal of Thoracic and Cardiovascular Surgery 3 (2008): 572-577.
  14. Valente T., et al. “MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report”. British Journal of Radiology1101 (2019): 20170980.
  15. Kirmani BH., et al. “A meta-analysis of computerized tomography scan for reducing complications following repeat sternotomy for cardiac surgery”. Interactive CardioVascular and Thoracic Surgery (ICVTS) 4 (2016): 472-479.
  16. Morishita K., et al. “Three or more median sternotomies for patients with valve disease: role of computed tomography”. Annals of Thoracic Surgery5 (2003): 1476-1480; discussion 1481.
  17. Yin CH., et al. “Effect analysis of repeat sternotomy in pediatric cardiac operations”. Journal of Cardiothoracic Surgery 10 (2015): 179.
  18. Esper SA., et al. “Pathophysiology of cardiopulmonary bypass: current strategies for the prevention and treatment of anemia, coagulopathy, and organ dysfunction”. Seminars in Cardiothoracic and Vascular Anesthesia 2 (2014): 161-176.


Citation: AES Malyshenko., et al. “Post-Operative Atrial Fibrillation and its Predisposing Factors After Cardiac Surgery". Acta Scientific Cardiovascular System 1.7 (2022): 14-17.

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US