{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:51:13Z","timestamp":1760057473380,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Repeat cardiac operations carry increased risk of morbidity and mortality due to adhesions between the heart and adjacent structures, which increase the complexity of redo sternotomy and the potential for reentry injury. Preoperative CT imaging has been associated with a decreased risk for reentry injury. Methods: We present a series of two cases of complex thorax reentry in which a stepwise sternotomy approach enabled safe reentry. Results: Both patients tolerated the procedure well, with successful orthotopic heart transplantation in each case. A thorough review of the preoperative CT imaging enabled surgical planning to safely navigate structures at high risk for reentry injury. Conclusions: This series demonstrates the utility of two-stage sternotomy in complex thorax reentry cases and the importance of preoperative imaging for the safe surgical planning of such an approach.<\/jats:p>","DOI":"10.3390\/jcm14041251","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T03:20:52Z","timestamp":1739503252000},"page":"1251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-Stage Sternotomy Approach to Hostile Chest Reentry for Orthotopic Heart Transplantation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5044-517X","authenticated-orcid":false,"given":"Alden J.","family":"Dunham","sequence":"first","affiliation":[{"name":"Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3149-7326","authenticated-orcid":false,"given":"Leonardo","family":"Paim N. da Costa","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of South Florida, Tampa, FL 33602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucian","family":"Lozonschi","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of South Florida, Tampa, FL 33602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jtcvs.2007.08.060","article-title":"Adverse events during reoperative cardiac surgery: Frequency, characterization, and rescue","volume":"135","author":"Roselli","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1093\/ejcts\/ezu261","article-title":"Incidence and outcome of re-entry injury in redo cardiac surgery: Benefits of preoperative planning","volume":"47","author":"Hamid","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.jtcvs.2010.07.086","article-title":"Identifying patients at particular risk of injury during repeat sternotomy: Analysis of 2555 cardiac reoperations","volume":"140","author":"Park","year":"2010","journal-title":"J Thorac Cardiovasc Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/S0003-4975(02)04821-X","article-title":"Three or more median sternotomies for patients with valve disease: Role of computed tomography","volume":"75","author":"Morishita","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1093\/bjaceaccp\/mkq024","article-title":"Deep hypothermic circulatory arrest","volume":"10","author":"Conolly","year":"2010","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1053\/j.jvca.2023.11.010","article-title":"Deep Hypothermic Circulatory Arrest: A Brief History and Where It Is Going","volume":"38","author":"Rybar","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jtcvs.2010.07.098","article-title":"Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest","volume":"141","author":"Williams","year":"2011","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"805","DOI":"10.21037\/jtd.2019.02.01","article-title":"Risk factors of delayed awakening after aortic arch surgery under deep hypothermic circulatory arrest with selective antegrade cerebral perfusion","volume":"11","author":"Wang","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/s13019-019-1027-3","article-title":"Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest","volume":"14","author":"Li","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1053\/j.jvca.2015.07.025","article-title":"Severity and Duration of Metabolic Acidosis After Deep Hypothermic Circulatory Arrest for Thoracic Aortic Surgery","volume":"29","author":"Ghadimi","year":"2015","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"857","DOI":"10.21037\/jtd-21-1494","article-title":"Partial upper sternotomy for aortic valve replacement provides similar mid-term outcomes as the full sternotomy","volume":"14","author":"Hlavicka","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1053\/j.semtcvs.2021.04.053","article-title":"Partial Upper Sternotomy is a Safe Alternative in Mitral Annulus Decalcification","volume":"34","author":"Oezpeker","year":"2022","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_13","first-page":"212","article-title":"David procedure through an upper partial sternotomy","volume":"4","author":"Shrestha","year":"2015","journal-title":"Ann. Cardiothorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1251\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:33:59Z","timestamp":1760027639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041251"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041251","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,2,14]]}}}