Strategies, Risks, and Outcomes in Cardiac and Aortic Reoperations

(Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan)

Yoshiyuki Takami Kazuyoshi Tajima Hisaaki Munakata
Makoto Hibino Kei Fujii Noritaka Okada
Yoshimasa Sakai
Cardiovascular reoperations involve high-risk because of adhesions. We examined the strategies and clinical outcomes of the reoperations in our institute. From January 2003 to December 2008, 52 patients underwent reoperations, accounting for 4.5% of all adult patients. The duration from the previous surgery was 10.1±9.3 years. Reoperations were performed due to infection(n=10), after valve surgery(n=16), after coronary surgery(n=9), due to Marfan syndrome(n=3), after aortic surgery(n=7), after congenital surgery(n=4), and for other reasons. In the reoperations, the same surgical site was exposed in 65%, the femoral vessels were exposed before re-sternotomy in 77%, the inflow was on the ascending aorta in 35%, and cardiopulmonary bypass was initiated before re-sternotomy in 37%. Systemic cooling was needed in 4 patients and some maneuvers for patent internal thoracic artery grafts in 6 patients. The operation time of 9.6±2.5 h and the cardiopulmonary bypass time of 295±111 min, respectively. We experienced intraoperative injuries in 16 patients(31%). Platelet transfusion was needed in 90% and a second CPB in 15%. Postoperative complications included hemorrhage(14%), infection(13%), stroke(4%), respiratory failure(44%), and renal failure(1%). The hospital mortality was 7.7%(4/52)due to uncontrolled infection, liver failure, pulmonary hemorrhage, and left ventricular rapture. The 2-year survival rate was 83.1% with the mean follow-up of 24±18 months. In conclusion, although the risk of injuries at re-sternotomy was not high, limited surgical field due to adhesions resulted in fatal injuries and in the cardiac reoperations we experienced. We need to improve our strategies for further reduction in mortality and morbidities in reoperations.
  Jpn. J. Cardiovasc. Surg. 39:105-110(2010)

Keywords:cardiovascular reoperation, redo, re-sternotomy, injuries