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Thorac Cardiovasc Surg 2022; 70(05): 377-383
DOI: 10.1055/s-0040-1719157
Original Cardiovascular

25 Years' Experience with Redo Operations in Cardiac Surgery—Third-Time Sternotomy Procedures

Leopold Rupprecht 
1   Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
,
Simon Schopka
1   Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
,
Andreas Keyser
1   Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
,
Dirk Lunz
2   Department of Anesthesiology, University Medical Center, Regensburg, Germany
,
Samuel Sossalla
3   Department of Cardiology, University Medical Center, Regensburg, Germany
,
Michael Hilker
1   Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
,
Christof Schmid
1   Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
› Author Affiliations Funding None.
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Abstract

Background Over the years, open heart surgery has become more complex, and especially reoperative surgery, more demanding. The risk of third-time or more sternotomy procedures is unclear.

Methods We reviewed our institutional experience of 25 years based on two generations of cardiac surgeons in a German university medical center to document frequency, outcome, and complications of the various types of open heart procedures.

Results Overall, we included 104 patients with a mean age of 64 ± 13 years. The EuroSCORE II (European System for Cardiac Operative Risk Evaluation) calculated an average mortality risk of 15.7 ± 15.4%. Subgroup comparison of isolated coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve replacement procedures did not delineate significantly different risk profiles except for the incidence of acute myocardial infarction, which was present in every second patient (53.3%) scheduled for CABG surgery. The time interval to previous surgery was 4.7 ± 6.3 years on average. Most frequent surgical procedures were valve operations, which were accomplished in 72 patients (69.2%), whereas coronary bypass surgery was performed in 23 patients (22.1%) only. Combined procedures were performed in 27 patients. Complex aortic arch replacement with a frozen elephant trunk procedure was necessary in six patients. Overall, 30-day survival was 81.7%.

Conclusion In conclusion, third-time and more sternotomy procedures offer acceptable outcome and should therefore be considered in appropriate patients.

Keywords

aortic valve or complete root - coronary artery bypass grafting - CABG - aortic valve surgery - reoperation

Authors' Contribution

L. Rupprecht: Conceptualization; data curation; formal analysis; investigation; project administration; methodology; writing—original draft.


S. Schopka: Writing—original draft, review, and editing; statistics.


A. Keyser: Writing—review and editing.


D. Lunz: Writing—review and editing.


S. Sossalla: Writing—review and editing.


M. Hilker: Writing—review and editing.


C. Schmid: Conceptualization; methodology; supervision; writing—original draft, review, and editing.


Prior or Related Publications

Kobuch R, Hilker M, Rupprecht L, Hirt S, Keyser A, Puehler T, Amman M, Zink W, Schmid C. Late reoperations after repaired acute type a aortic dissection. J Thorac Cardiovasc Surg 2012;144:300–307.




Publication History

Received: 06 July 2020

Accepted: 10 September 2020

Article published online:
24 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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