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Redo aortic surgery: Does one versus multiple affect outcomes?

Elizabeth L Norton1, Kanika Kalra1, Bradley G Leshnower1

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JTCVS Open
|January 11, 2024
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Summary
This summary is machine-generated.

Redo aortic surgery after multiple previous operations carries higher short-term mortality than first redo surgery. However, long-term survival remains similar regardless of the number of prior cardiac procedures.

Keywords:
first redomultiple redoredo aortic surgery

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery Outcomes

Background:

  • Redo aortic surgery presents increased risks due to adhesions, infection, and prior prostheses.
  • Comparing outcomes after one versus multiple previous cardiac operations is crucial for risk stratification.

Purpose of the Study:

  • To benchmark outcomes of redo aortic surgery based on the number of prior cardiac operations.
  • To identify risk factors associated with mortality in redo aortic surgery.

Main Methods:

  • Retrospective analysis of 429 patients undergoing redo aortic surgery between 2004 and 2019.
  • Patients were categorized into first redo surgery (n=360) and multiple redo surgery (n=69).
  • Comparison of postoperative outcomes and long-term survival, with risk factor analysis for mortality.

Main Results:

  • Thirty-day mortality was significantly higher in the multiple redo surgery group (21.7%) compared to the first redo surgery group (12.3%).
  • Independent predictors of 30-day mortality included age, cardiopulmonary bypass time, intra-aortic balloon pump use, and multiple redo surgery.
  • While short-term outcomes differed, long-term survival at 15 years was similar between groups. Multiple redo surgery patients experienced longer bypass and crossclamp times and higher rates of dialysis.

Conclusions:

  • Multiple redo aortic procedures are associated with increased short-term morbidity and mortality compared to first redo aortic procedures.
  • Short-term mortality risk increases linearly with the number of redo procedures.
  • Long-term survival is comparable, irrespective of the number of previous redo aortic surgeries.