[Operative strategy for redo heart valve operation]

Thirty-five redo heart valve operations were performed between Jan. 1990 and Dec. 1993 in Jichi Ohmiya Medical Center. Previous operations were mitral valve replacement (MVR) in 19, closed mitral commissurotomy in 1, open mitral commissurotomy in 6, aortic valve replacement (AVR) in 5, ASD repair in 3, VSD repair in 1. Thirty (85.7%) were in NYHA functional class III or less, and 5 (14.3%) were in functional class in IV. Twenty-three patients had undergone MVR, 5 AVR, 4 MVR+AVR, 2 TVR (TAP), 1 Cabrol operation, and 8 patients had undergone concomitant tricuspid valve repair. Emergent operation was none. Overall operative mortality was 5.7% (2/35), as the cause of death was low output syndrome. Chest CT was available for the evaluation of the distension of right atrium and right ventricle. Catastrophic hemorrhage by the injury of ascending aorta or right atrium during redo sternotomy was 4, but that was not the cause of death. We emphasize the necessity of the exposure of the femoral artery and the preparation for cardiopulmonary bypass before sternotomy. The extent of dissecting adhesion should be determined case by case respectively under consideration of the risk of cardiovascular injury and postoperative large bleeding. Furthermore the cannule of SVC or IVC with cuff was useful for the cases with strong adhesion.