Background:
Redo sternotomy for cardiac surgery is a significant risk factor, and in the era of transcatheter-aortic-valve-implantation (TAVI), patients requiring redo AVR are often referred for TAVI to avoid redo sternotomy. The objective of our study is to analyze outcome of all patients undergoing redo sternotomy for AVR.
Methods:
Since 2004, 2191 patients underwent AVR, and 426 (19%) were redo sternotomy. Our study included 383 patients after excluding dissections or ascending aorta repair combined with AVR. There were 188 isolated redo AVR (49%). Previous cardiac operation included: 44% CABG, 43% AVR, 21% MV, 3% TV and 11% other procedures. Mean age was 64±15 (range 15-86) and 63% were males. Logistic EuroScore and preoperative LVEF were 18±16% and 51±11%.
Results:
In hospital mortality was 7%. Mean (and median) ICU time and ventilation time, were: 107±189 hours (46) and 57±141 hours (15). After excluding redo AVR which are not candidates for TAVI (endocarditis, mechanical-valve, small bioprosthesis, bicuspid AV) early mortality was 7%, (12 from 173 potential TAVI candidates). Mortality was 9% before 2009, and 3% in the TAVI era, p=0.22.
Major complications in the 173 TAVI candidates included re-opening for bleeding/tamponade in 10%, ventilation >48 hours in 18%, tracheostomy in 3%, CVA/TIA in 3%, renal-replacement-therapy in 2%, deep wound infection in 2%, and permanent pacemaker in 3%. Significant predictors for in hospital early mortality were: older age, EuroScore and lower ejection-fraction. Previous CABG was not a predictor for adverse outcome (mortality/major morbidity).
Conclusions:
Re operation for AVR can be safely done with acceptable early results. There is a trend to selection of lower-risk patients for redo AVR in the TAVI era. Selection for redo AVR should be done carefully to optimize outcome, mainly in the older population.
