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

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery Outcomes

Background:

• Open heart surgery, particularly reoperative procedures, is increasing in complexity.
• The risks associated with undergoing sternotomy three or more times remain unclear.
• Evaluating outcomes of complex reoperations is crucial for patient selection and surgical planning.

Purpose of the Study:

• To analyze a 25-year institutional experience with complex open heart reoperations.
• To document the frequency, outcomes, and complications of multiple sternotomy procedures.
• To assess the safety and efficacy of third-time or more sternotomy surgeries.

Main Methods:

• Retrospective review of 104 patients undergoing open heart surgery at a German university medical center over 25 years.
• Analysis of surgical procedures including valve replacement, coronary artery bypass grafting (CABG), and complex aortic arch repair.
• Evaluation of patient demographics, EuroSCORE II risk assessment, and 30-day survival rates.

Main Results:

• The study included 104 patients with a mean age of 64 years; the average predicted mortality risk (EuroSCORE II) was 15.7%.
• Valve operations were most frequent (69.2%), followed by CABG (22.1%). Acute myocardial infarction was common in CABG patients (53.3%).
• Overall 30-day survival was 81.7%, indicating acceptable outcomes despite the complexity of reoperative sternotomy.

Conclusions:

• Third-time or more sternotomy procedures can yield acceptable outcomes in carefully selected patients.
• These complex reoperations should be considered when appropriate, given the demonstrated survival rates.
• Further research may refine patient selection criteria for multiple sternotomies.