Reoperation for acquired valvular heart disease--operative method and surgical results

Between January, 1982 and December, 1989, 102 reoperations (repeat median sternotomy) in 101 patients with valvular heart disease were performed at Kurume University Hospital. In these operations, the heart was not mobilized from the pericardium to prevent tearing the heart or great vessels. All operative procedures were performed through the pericardium which adhered tightly to the heart. Adequate left ventricular hypothermic protection was obtained without total dissection of the heart by cold crystalloid cardioplegic solution and topical cooling which was accomplished by filling the left pleural space with cold saline during the operation. As to the surgical results, the early mortality rate was 4.0%, and the late mortality rate was 5.2%. The causes of death were not related to the operative procedures or perioperative myocardial protection. There was no significant difference in the early mortality rate between the reoperations and the initial operations. These results suggest that reoperation for valvular heart disease should be performed before the hemodynamic condition of the patient deteriorates.