Our Strategy for Reoperative Cardiac Surgery

Yoichi Kikuchi, Tikara Shiiku, Yoshiyasu Atsuta, Yasutaka Tsutsui

National Obihiro Hospital, Obihiro, Japan

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objectives: Division of the sternum in reoperative cardiac surgery carries an increased risk of re-entry injury for major cardiac structures in the presence of adhesion between the sternum and the mediastinal structures. These mishaps occur regularly and clearly contribute to morbidity and mortality. To avert these catastrophic events, establishing the cardiopulmonary bypass (CPB) before sternotomy is one of the dominant strategies. We reviewed our experiences with reoperative cardiac surgery and conducted the study about usefulness of CPB before resternotomy.

Methods: From 2005 to 2016, 98 patients underwent reoperative cardiac operation in our hospital. Among those cases, 53 patients (54%) underwent resternotomy under CPB before sternotomy. The procedures were as follows: aortic valve disease; 32 (32.7%), mitral disease; 35 (26.5%), tricuspid valve disease; 3 (3%), aortic aneurysm; 17 (17.3%), re-CABG; 8 (8.2%), others; 3 (3%).

Results: Injuries to mediastinal structure were occurred in 4 patients. All patients were third or more reoperation. Right atrial injury was occurred in 2 patients without CPB before sternotomy. Previously used aortic cannulation site which was enforced with felt pledget severely adhesed to the sternum was injured in 2 patients despite commencing of CPB before sternotomy. Over all 30 day mortality was 5.1%, and in-hospital mortality was 5.1%. There were no statistical differences between CPB group and non-CPB group as for postoperative mortality and morbidity. In the long term, there is no significant difference in survival between the two groups.

Conclusions: Extracorporeal circulation before resternotomy would be indicated in close adhesion between the sternum and anterior cardiac structures such as enlarged ascending aorta or previously replaced ascending aortic graft, distended right ventricle due to severe tricuspid regurgitation, hemodynamic instability, depressed ejection fraction and exist of open IMA graft.