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[Operative strategy for redo heart valve operation]

A Mizuhara1, T Ino, H Adachi

  • 1Department of Cardiovascular Surgery, Jichi Medical School, Ohmiya Medical Center, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|July 1, 1994
PubMed
Summary

Redo heart valve surgery requires careful planning. Pre-operative exposure of the femoral artery and preparing for cardiopulmonary bypass are crucial for patient safety and minimizing operative risks.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Thoracic Surgery

Context:

  • Redo heart valve operations present unique challenges compared to primary procedures.
  • Thirty-five redo cardiac surgeries were performed between 1990 and 1993.
  • Previous operations included mitral valve replacement, aortic valve replacement, and septal defect repairs.

Purpose:

  • To evaluate the outcomes and identify critical considerations for redo heart valve surgery.
  • To highlight strategies for managing adhesions and preventing complications during re-sternotomy.

Summary:

  • The study involved 35 patients undergoing repeat heart valve operations, with most in NYHA functional class III or less.
  • Overall operative mortality was 5.7%, with low output syndrome as the primary cause of death.

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  • Hemorrhage from ascending aorta or right atrium injury occurred in 4 cases but was not fatal.

    • Impact:

    • Emphasizes the necessity of exposing the femoral artery and preparing for cardiopulmonary bypass before sternotomy.
    • Recommends case-by-case determination of dissection extent to balance cardiovascular injury risk and bleeding.
    • Suggests using cannulae with cuffs for superior and inferior vena cava in cases with significant adhesions.