Catastrophic hemorrhage due to aortic injury during resternotomy: what to do?

Aortic injury occurred during resternotomy in a 22-year-old woman who had undergone a Rastelli-type operation. Although extracorporeal circulation using the right femoral artery and vein was commenced immediately, hemostasis through the midline incision was impossible, and her circulation was hardly maintained. Thus, the parasternal approach was attempted, dividing the right first through fourth ribs and the head of the right clavicle. This approach enabled the assistant to give effective compression to the aortic injury site. Dissection of the adhesions around the ascending aorta was safely carried out, and the aortic laceration was closed without the help of circulatory arrest.