Abstract Background There is a high risk of injury to retrosternal cardiac structures in patients undergoing redo-sternotomy; cross sectional imaging is critical in this risk assessment. The presence of retrosternal adhesions can be assessed by real time cine (RTC) cardiovascular magnetic resonance (CMR) imaging, which provides a dynamic assessment. Purpose To retrospectively review our practice of using RTC imaging to determine the presence of retrosternal adhesions and, additionally, our assessment of lower limb vascular access prior to redo sternotomy. Methods We identified all patients who underwent redo median sternotomy between October 2024 and April 2025 with prior CMR studies that included RTC imaging. The RTC sequence was triggered balanced Steady-State Free Precession (bSSFP) cine acquisition with GRAPPA (Generalised Autocalibrating Partially Parallel Acquisition), with an acceleration factor of 2. The peripheral lower limb vessels were assessed by True-FISP (True Fast Imaging with Steady-State Precession) as a transaxial stack from the diaphragm to the superficial femoral vessels. The presence of retrosternal adhesions and vessel complications were identified from operation notes. Results 22 paediatric and 19 adult patients were identified; mean age at CMR and operation was 18 years (± 17) and 20 years (± 16), respectively. The male to female ratio was 4:1. Preoperative retrosternal adhesions were identified on RTC imaging in 10 patients and confirmed in 6 (60%), Table 2. In 14 patients, no adhesions were identified on CMR but retrosternal adhesions were evident intra-operatively. The specificity was 80% (CI ± 17%), sensitivity 30% (CI ± 20%), false positive rate 19% and false negative rate 70%. The ilio-femoral vessels were assessed on CMR in 31 patients and deemed unobstructed in 29 patients (94%). No intraoperative femoral access complications were recorded. Conclusions In our cohort, RTC imaging predicted the presence of significant retrosternal adhesions in a proportion of patients with high specificity, but a high false negative rate was evident. Of note, deep breathing during the scan acquisition was not performed and may account for this reduced accuracy, particularly in patients with multiple re-sternotomies. Whilst no lower limb vascular complications were encountered intraoperatively, more robust prospective validation of both sternal and lower limb access protocols are needed.Table 1:Baseline patient characteristics Table 2.Retrosternal adhesion findings
Gopaul et al. (Thu,) studied this question.