Post-Sternotomy Complications: Aortic Erosion and Pseudoaneurysm Formation Caused by Fractured Sternal Steel Band Wire

TL;DR

A patient with a fractured sternal steel band wire developed aortic erosion and a pseudoaneurysm, requiring complex surgical repair.

Contribution

Presents a novel surgical approach using deep hypothermic circulatory arrest for high-risk aortic pseudoaneurysm repair.

Findings

Fractured sternal steel wire caused ascending aortic perforation and pseudoaneurysm formation.

Peripheral CPB cannulation and deep hypothermic arrest enabled safe resternotomy and repair.

Patient fully recovered after complex surgery in a high-volume aortic center.

Abstract

A 66-year-old man with a history of homograft implantation in aortic position 30 years ago, was referred with an actively bleeding sternotomy wound.

Computed tomography revealed perforation of the ascending aorta by the most cranial steel band wire, forming a large pseudoaneurysm. Surgery in deep hypothermic circulatory arrest included wire removal and pseudoaneurysm repair. On the 1st postoperative day (POD), significant mediastinal bleeding required revision surgery, leading to ascending aorta replacement. The patient fully recovered and was discharged on the 33rd POD.

Conventional resternotomy was deemed too risky, even with cardiopulmonary bypass (CPB) support. Instead, peripheral CPB cannulation, cooling to 18 °C and resternotomy with the patient under circulatory arrest were the method of choice. Left ventricular (LV) venting via a left-side minithoracotomy prevented LV distention, which was critical owing to mild-to-moderate aortic valve incompetence and risk of ventricular tachycardias.

Repair of the pseudoaneurysm was achieved safely; however, these procedures should be performed in high-volume centers specialized in aortic surgery.

Figures