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Early Mortality in Reoperative Cardiac Surgery: Determinants, Prediction, and Calibration
Abdul Kerim Buğra1, Tuba Mutu1, Burak Ersoy1
1Cardiovascular Surgery Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, 34303 Istanbul, Türkiye.
Diagnostics (Basel, Switzerland)
|August 13, 2026
Summary
Early death after redo cardiac surgery is linked to preoperative conditions and procedural complexity. A new risk model shows promise, while EuroSCORE II underestimates mortality risk in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Outcomes Research
Background:
- Reoperative (redo) cardiac surgery has higher risks than primary procedures.
- Determinants of early mortality in valve and endocarditis-focused redo surgery cohorts are not well understood.
Purpose of the Study:
- Identify preoperative factors predicting early mortality in redo cardiac surgery.
- Develop a clinical risk prediction model for early death.
- Analyze causes of death and evaluate the EuroSCORE II's accuracy.
Main Methods:
- Analysis of 821 redo cardiac operations via repeat sternotomy (December 2010-December 2025).
- Multivariable logistic regression to identify independent preoperative predictors of mortality.
- Comparison of a new model's discrimination and calibration against EuroSCORE II.
Main Results:
- Early mortality rate was 22.8%. Key predictors included chronic kidney disease, age ≥70, active endocarditis, advanced functional class, non-elective status, and pulmonary artery pressure.
- The developed model showed good discrimination (C-statistic 0.755).
- EuroSCORE II underestimated mortality (observed-to-expected ratio 1.46) and mortality increased with procedural complexity and hemodynamic support.
Conclusions:
- Early mortality in redo cardiac surgery is associated with preoperative comorbidities, procedural complexity, and low-cardiac-output physiology.
- Failure-to-rescue significantly contributes to mortality.
- A new preoperative model accurately predicts risk; EuroSCORE II requires recalibration for redo cardiac surgery assessment.
