Adverse events during reoperative cardiac surgery: Frequency, characterization, and rescue

Roselli, Eric E.; Pettersson, Gösta; Blackstone, Eugene H.; Brizzio, Mariano E.; Houghtaling, Penny L.; Hauck, Regina; Burke, Jacob; Lytle, Bruce W.

doi:10.1016/j.jtcvs.2007.08.060

Cited by 153 publications

(109 citation statements)

References 16 publications

(17 reference statements)

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“…A (very) high BMI may cause more postoperative death by complications such as deep sternal infection, renal failure, or respiratory failure [13]. Previous CABG is known to increase the risk of inhospital mortality after redo cardiac surgery by intraoperative adverse events such as injury to bypass grafts, heart or great vessels [14]. Patients requiring AVR after previous CABG seem to be particularly at risk, possibly due to older age and the presence of left ventricular hypertrophy [15].…”

Section: Discussionmentioning

confidence: 99%

Predicting 30-day mortality of aortic valve replacement by the AVR score

et al. 2011

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Objectives The objective of this study is to develop a simple risk score to predict 30-day mortality of aortic valve replacement (AVR). Methods In a development set of 673 consecutive patients who underwent AVR between 1990 and 1993, four independent predictors for 30-day mortality were identified: body mass index (BMI) ≥30, BMI <20, previous coronary artery bypass grafting (CABG) and recent myocardial infarction. Based on these predictors, a 30-day mortality risk score-the AVR score-was developed. The AVR score was validated on a validation set of 673 consecutive patients who underwent AVR almost two decennia later in the same hospital. Results Thirty-day mortality in the development set was ≤2% in the absence of any predictor (class I, low risk), 2-5% in the solitary presence of BMI ≥30 (class II, mild risk), 5-15% in the solitary presence of previous CABG or recent myocardial infarction (class III, moderate risk), and >15% in the solitary presence of BMI <20, or any combination of BMI ≥30, previous CABG or recent myocardial infarction (class IV, high risk). The AVR score correctly predicted 30-day mortality in the validation set: observed 30-day mortality in the validation set was 2.3% in 487 class I patients, 4.4% in 137 class II patients, 13.3% in 30 class III patients and 15.8% in 19 class IV patients. Conclusions The AVR score is a simple risk score validated to predict 30-day mortality of AVR.

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Section: Discussionmentioning

confidence: 99%

Predicting 30-day mortality of aortic valve replacement by the AVR score

et al. 2011

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“…24) Many recent studies have indicated that the number of previous sternotomies does not increase the risk of reentry injuries to the heart and great vessels, 21) with a life-threatening injury only being reported in 7% to 9% of patients during reoperation. 25,26) Direct vision resternotomy has been associated with zero, moderate, or major cardiac injury/catastrophic hemorrhage during reoperation. 27) A change to the surgical technique to include minimal dissection of the heart has contributed to shorter aortic cross clamping and CPB times.…”

Section: Surgical Approachmentioning

confidence: 99%

Redo Valve Surgery—Current Status and Future Perspectives

Furukawa

Tanemoto

2014

ATCS

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Surgeons are now facing the challenge of redo valve surgery because of the increasing number of elderly individuals in Japan. The incidence of bioprosthesis dysfunction has increased among the various surgical indications of redo valve surgery due to the preference of patients and a paradigm shift in prostheses from mechanical valves to bioprostheses. Previous studies reported that the clinical outcomes of reoperative valvular surgery have markedly improved due to the maneuver of myocardial protection, cardiopulmonary bypass strategies, and appropriate safer surgical approach. The general surgical outcomes of redo valve surgery have been reported as being similar to those of primary valve surgery; however, this is still controversial and has not yet been confirmed in some developed countries. Although the unique surgical technique of transcatheter valve-in-valve implantation for bioprosthetic dysfunction is promising, redo valve surgery may become more prevalent in the future. We here reviewed the current status of reoperative valve surgery and future perspectives including catheter-based surgical interventions.

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“…2 Adverse events during reoperative CABG occur more frequently when PSS are not used when warranted, and the omission of which translates into poor patient outcome and higher cost. 3 CTA has been shown to have strong association with the adoption of PSS in patients with high-risk findings. 2 Use of CTA has also been demonstrated to shorten perfusion and cross clamp time and decrease the rates of perioperative stroke and myocardial infarction in reoperative CABG patients.…”

mentioning

confidence: 97%

Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting

Gada

Desai

Marwick

2012

Circ: Cardiovascular Quality and Outcomes

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Background-The risks of repeat thoracotomy can be reduced if thoracic multidetector computed tomographic angiography (CTA) is used to guide preventive surgical strategies (PSS: peripheral cardiopulmonary bypass, circulatory arrest, and nonmedian sternotomy). We sought to define the cost-effectiveness of CTA using a Markov model. Methods and Results-We studied outcomes and costs of CTA and non-CTA strategies in a modeled cohort of 10 000 patients undergoing redo coronary artery bypass grafting. Rates of PSS implementation were anticipated to follow identification of risk by CTA. Transitions, costs, and utilities were informed by our experience and the literature. Sensitivity analyses included testing a range of costs of CTA and PSS on model outcome. In the reference case, cost and quality-adjusted life years accrued with the use of CTA ($74 869, 4.63 quality-adjusted life-years) were slightly higher than nonuse ($73 471, 4.59 quality-adjusted life-years), yielding an incremental cost-effectiveness ratio of $34 950/quality-adjusted life-years. Cost of PSS (equipment and operating time) was the most significant determinant of incremental cost-effectiveness ratio.In the reference case (cost of CTA ≈$300), identification and avoidance of potential procedural difficulties with CTA rendered it cost-effective if the cost of PSS was <$12 000. Across a range of CTA costs, incremental cost-effectiveness ratio was not materially influenced by outcomes across a broad range of imputed values. Conclusions-The cost of CTA appears justified in the setting of isolated reoperative coronary artery bypass grafting, because it aids in appropriate selection of PSS. The cost-effectiveness of this imaging seems more influenced by the costs of subsequent PSS than by the cost of CTA. (Circ Cardiovasc Qual Outcomes. 2012;5:705-710.)

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Adverse events during reoperative cardiac surgery: Frequency, characterization, and rescue

Cited by 153 publications

References 16 publications

Predicting 30-day mortality of aortic valve replacement by the AVR score

Predicting 30-day mortality of aortic valve replacement by the AVR score

Redo Valve Surgery—Current Status and Future Perspectives

Cost-Effectiveness of Computed Tomographic Angiography Before Reoperative Coronary Artery Bypass Grafting

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