Multiple Reoperation in Cardiac Surgery: Early Outcomes with Routine Use of Peripheral Bypass Cannulation

Background: The number of reoperations in cardiac surgery increases with the increase in the age of the general population and with the advance in surgical technology. Reoperations are technically more challenging due to mediastinal adhesion associated with the risk for reentry injury leading to increased perioperative morbidity and mortality.

Objectives: The aim of the study is to evaluate early outcomes of multiple reoperations and the routine use of peripheral cannulation in very high risk patients.

Methods: Between January 2004 and June 2018, 1565 patients underwent redo operation, 314 of them (mean age 60±14 years, male 55%) underwent multiple redo operations (>2 cardiac surgeries). peripheral cannulation was used routinely. We evaluated retrospectively the early outcomes.

Results: There was no intra-operative death. In hospital mortality was 10% (30 patients) with no correlation to reentry injury or peripheral bypass cannulation. The mean duration from preceding operation was 14y±11y. Patients underwent multiple previous operations (2-76%, 3-18%, 4-5%, 5- 0.6%, 6-0.4%), that included CABG 25% (79/314), AV 37% (136/314), MV 49% (153/314), TV 16% (51/314) Aorta 32% (99/314). In this high risk population (Log.Euroscore 17.2±15.7, LVEF 49±18%), operation indicated was on MV 46% (145/314), AV 42% (131/314), TV 34% (107/314), PV 4% (13/314), Aorta 13% (40/314), CABG in 5% (17/314) of them Endocarditis was involved in 8%. Cardiopulmonary bypass time, hospital stay and ICU stay :157±97min, 13±12d, 5.8±9.9d, respectively. There were 19% major complications (3% CVA, 1% TIA, 4% low cardiac output, 8% dialysis, 3% IABP and 5% pacemaker implantation).

Conclusion: Despite surgical challenges and high risk patients, early outcomes of multiple cardiac surgery reoperation are acceptable. The use of routine peripheral cannulation is advocated to prevent intraoperative adverse events.