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Precise Endoballoon Positioning for High-Risk Sternal Re-Entry in an Ascending Aortic Pseudoaneurysm with Patent Coronary Grafts
  • Katie E. O’ Sullivan,
  • Anand Mehta,
  • Patrick Vargo
Katie E. O’ Sullivan
Cleveland Clinic Department of Thoracic and Cardiovascular Surgery

Corresponding Author:[email protected]

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Anand Mehta
Cleveland Clinic
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Patrick Vargo
Cleveland Clinic Department of Thoracic and Cardiovascular Surgery
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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.
13 Jun 2022Submitted to Journal of Cardiac Surgery
13 Jun 2022Submission Checks Completed
13 Jun 2022Assigned to Editor
14 Jun 2022Reviewer(s) Assigned
06 Jul 2022Review(s) Completed, Editorial Evaluation Pending
06 Jul 2022Editorial Decision: Revise Minor
11 Jul 20221st Revision Received
06 Sep 2022Submission Checks Completed
06 Sep 2022Assigned to Editor
06 Sep 2022Reviewer(s) Assigned
23 Sep 2022Review(s) Completed, Editorial Evaluation Pending
23 Sep 2022Editorial Decision: Accept