Staged reoperation: a novel strategy for high-risk patients

A staged reoperative approach may be advantageous in improving surgical outcomes in patients who require multiple reoperations. Patients undergo redo sternotomy and mediastinal dissection only to the extent necessary to perform the indicated procedure. After chest tubes are placed and the sternum and soft tissues are temporarily closed, patients are taken to the postoperative intensive care unit until normothermia is achieved, clotting studies are within normal limits, and chest tube output is nominal. Patients are subsequently returned to the operating room for heparinization, cannulation, and initiation of cardiopulmonary bypass to perform the indicated procedure.