Precise Endoballoon Positioning for High-Risk Sternal Re-Entry in an
Ascending Aortic Pseudoaneurysm with Patent Coronary Grafts
Redo cardiac surgery can present a unique set of challenges even to the
experienced surgeon. Although outcomes have steadily improved in the
modern era; if an intraoperative adverse event occurs, there is a 5%
incidence of mortality and 19% incidence of myocardial infarction,
stroke or death [(1)](#ref-0001). Overall, the modern incidence of
mortality at reoperation varies but be segregated into low and higher
risk cohorts depending on the planning computed tomography imaging and
risk to substernal structures on re-entry [(2, 3)](#ref-0002).
Patients with ascending aortic or root pseudoaneurysms represent a
particularly difficult subset of high-risk patients requiring
re-operative cardiac surgery due to the danger of exsanguination and air
embolization [(4)](#ref-0004). Some surgeons advocate the use of
deep hypothermic circulatory arrest (DHCA) to achieve safe re-entry in
such cases however this can result in unpredictable DHCA duration
depending on the degree of pericardial adhesions [(5)](#ref-0005).
We report a case of aortic pseudoaneurysm in a patient with patent
coronary grafts managed using an endoballoon precisely positioned
relative to the proximal anastomoses resulting in a safe surgical
re-entry and shorter DHCA time.