Substernal thoracoscopic guidance during sternal reentry

Reentry sternotomy is commonplace, as more patients are returning for second, third, or more repeat cardiac procedures. Catastrophic hemorrhage remains the most dreaded complication during reentry and carries a significant morbidity and mortality. Although various methods are used to reduce the risk of hemorrhage, we have found that substernal thoracoscopy is preferable. Our experience with this technique in both adults and children is presented.