Abstract
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). 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). 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). 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). 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.