A Protocol-Driven Approach to Cardiac Reoperation Reduces Mortality and Cardiac Injury at the Time of Resternotomy

LaPar, Damien J.; Ailawadi, Gorav; Harris, David A.; Hajzus, Vanessa A.; Lau, Christine L.; Kern, John A.; Krön, Irving L.

doi:10.1016/j.athoracsur.2013.03.061

Cited by 24 publications

(17 citation statements)

References 19 publications

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“…Despite this improvement in outcomes for the redo mitral valve surgery cohort, the O/E for first-time mitral valve surgery did not significantly change over the study period. The improvements in redo mitral valve surgery may be due to a protocolised approach to redo surgery as suggested by LaPar et al 5 demonstrating the use of a protocol for redo sternotomy lowers mortality. When evaluating a patient requiring repeat mitral intervention after prior mitral valve surgery, it is important to note that risk of redo surgery has dramatically improved over the study period and is currently significantly better than predicted.…”

Section: Discussionmentioning

confidence: 99%

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Contemporary outcomes in reoperative mitral valve surgery

Mehaffey

Hawkins

Schubert

et al. 2017

Heart

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116

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Section: Discussionmentioning

confidence: 99%

“…Additionally, the improvement in cardiac care over the past decade has led to an increase in the number of patients offered reoperative mitral valve surgery 5. This increasing incidence likely further contributes to continued improvement in outcomes, particularly in high volume centres.…”

Section: Introductionmentioning

confidence: 99%

Contemporary outcomes in reoperative mitral valve surgery

Mehaffey

Hawkins

Schubert

et al. 2017

Heart

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116

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“…In general, adverse events are found in 4% to 7% of operations of which 23% occur during re‐entry and 39% during subsequent dissection. The internal thoracic artery remains one of the structure most frequently damaged, with associated mortality up to 23% 2,8‐10 . This could increase by up to 35% when the right ventricle is damaged 1 .…”

Section: Discussionmentioning

confidence: 99%

Video‐assisted thoracoscopic sternal adhesiolysis before resternotomy reduces morbidity and improves patient care

Vanstraelen

Yilmaz

2020

J Card Surg

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Background: Resternotomy still carries an important risk for an already high-risk population. Re-entry injuries may lead to massive bleeding, which can be difficult to control due to poor accessibility. The aim of the study was to assess early outcomes of video-assisted thoracoscopic adhesiolysis, as well as safety and feasibility.Methods: Forty-five patients received a video-assisted thoracoscopic adhesiolysis before resternotomy between April 1, 2016 and January 1, 2019. Records were reviewed for demographics, perioperative and early postoperative (Postop) outcomes. Results: The median age of the population was 73 years with a EUROSCORE II of 8.322. Only 1 (2.22%) patient experienced a major and 2 (4.44%) a minor re-entry injury. This resulted in a mean peroperative and 24-hour Postop blood loss of, respectively, 675.72 (range: 5-2862) and 444.71 mL (range: 0-2100). There was no significant difference between the use of minimally invasive and classic extracorporeal circulation (P = .276 and P = .81, respectively). Twenty-nine patients (64%) were not in need of red blood cell transfusion. A survival rate of 93.33% could be achieved. No deaths (n = 3) were related to the video-assisted thoracoscopic adhesiolysis or re-entry injuries. Kidney function remained stale postoperatively with creatinine preoperative and Postop levels of 1.56 (95%confidence interval:1.07-2.05) and 1.43 (95%CI, 1.05-1.81) mg/dL (P = .264). Despite high-risk surgery, the median length of stay was 8 days.Conclusion: A video-assisted thoracoscopic approach allows for a safe and effective adhesiolysis, due to increased visibility and accuracy. This approach may prevent major and minor re-entry injuries and consequently reduce perioperative morbidity and mortality of high-risk surgery. K E Y W O R D S resternotomy, sternal adhesiolysis, video-assisted thoracic surgery

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“…11,12 As part of a protocol for reoperative sternotomy, CT scans have been shown to reduce operative mortality. 13 Clearer understanding of myocardial protection has also aided in the safe conduct of redo operations. Minimal manipulation is important when handling atherosclerotic vein grafts to avoid potential embolic damage to myocardial territories.…”

Section: Closingmentioning

confidence: 99%

Reoperative Aortic Valve Replacement After Previous Coronary Artery Bypass Grafting or Aortic Valve Replacement

Lee

Moon

2014

Operative Techniques in Thoracic and Cardiovascular Surgery

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Redo surgery after prior coronary artery bypass grafting (CABG) is becoming more common. Often, a degenerative, stenotic aortic valve is the primary indication for such an operation. Additionally, a failing mechanical or bioprosthetic valve also necessitates re-operation. These operations present some unique challenges, including safe sternal re-entry, preservation of patent grafts, identification and control of internal mammary artery grafts, and careful planning of the aortotomy. In this report, we describe our technique for conducting this operation safely.

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A Protocol-Driven Approach to Cardiac Reoperation Reduces Mortality and Cardiac Injury at the Time of Resternotomy

Cited by 24 publications

References 19 publications

Contemporary outcomes in reoperative mitral valve surgery

Contemporary outcomes in reoperative mitral valve surgery

Video‐assisted thoracoscopic sternal adhesiolysis before resternotomy reduces morbidity and improves patient care

Reoperative Aortic Valve Replacement After Previous Coronary Artery Bypass Grafting or Aortic Valve Replacement

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