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Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures
Mehrdad Ghoreishi1, Murtaza Dawood1, Gerald Hobbs2
1Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
The Annals of Thoracic Surgery
|September 4, 2013
Summary
Reoperative mitral valve surgery outcomes are favorable and comparable to first-time operations when employing careful planning and protective strategies. This study found no increased mortality for repeat sternotomy mitral valve procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Reoperative mitral valve (MV) surgery is increasing, comprising over 10% of MV operations in the US.
- Previous studies reported higher mortality (5-18%) and reentry injury (5-10%) rates for reoperative MV procedures.
Purpose of the Study:
- To evaluate the outcomes of reoperative mitral valve operations.
- To compare the safety and efficacy of repeat sternotomy for MV procedures with first-time sternotomy.
Main Methods:
- Analysis of 1,056 MV operations (2004-2012), including 130 repeat sternotomies.
- Preoperative CT scans and systematic protective strategies were used for repeat sternotomy patients.
- Multivariable analysis identified factors associated with operative mortality.
Main Results:
- Reoperative MV operations had a 4.6% operative mortality, identical to first-time sternotomy (4.6%).
- Repeat sternotomy resulted in a 1.5% intraoperative injury rate (innominate vein).
- Repeat sternotomy was not independently associated with operative mortality.
Conclusions:
- Contemporary reoperative MV operations yield favorable outcomes.
- Careful planning and execution ensure outcomes for reoperative MV surgery are comparable to first-time operations.
Keywords:
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