Zero re-entry site injury in redo cases: A new easy, safe and reproducible femoral vein cannulation technique

Abstract

Background: Despite high progress in surgical techniques and medical strategies, mortality seems higher in redo cases than in primary surgery. Redo cardiac surgery is challenging. Scarring of tissues leading to loss of anatomical planes and adhesions increases the risk of injury during re-entry. It is important to implement safe strategies to prevent such injuries in this cohort of patients.
Objectives: We investigated the outcome of redo patients with a new simple, reproducible technique using pre-operative chest computed tomography without contrast and peripheral femoral site cannulation with the use of a new technique of femoral venous cannulation and initiation of cardiopulmonary bypass pre-sternotomy in redo patients.
Patients and Methods: A prospective analytical study involved 97 redo patients between July 2018 and June 2021. All patients were operated by the same surgical technique involved pre sternotomy femoral cannulation and initiation of cardiopulmonary bypass. All patients candidate for redo surgery were involved, there were no exclusion criteria, we used our modified technique for peripheral femoral cannulation using a simple, reproducible, and safe strategy to avoid fatal re-entry injuries.
Results: There was no re-entry site injury, very low peripheral femoral site cannulation complications, and hospital mortality 6% due to other causes rather than fatal re-entry site injury.
Conclusion: We believe that our simple modified technique of pre-operative mandatory CT scan of the chest, and pre-sternotomy peripheral femoral cannulation, and initiation of CPB were very promising in achieving zero re-entry site injury in redo cardiac surgery cases.