Modern Practice and Outcomes of Reoperative Cardiac Surgery

ABSTRACT Objective To evaluate recent practice and outcomes of reoperative cardiac surgery via resternotomy. Use of early versus late institution of cardiopulmonary bypass (CPB) before sternal re-entry was of particular interest. Methods From January 2008 to July 2017, 7,640 patients underwent reoperative cardiac surgery at Cleveland Clinic. The study group consisted of 6,627 who had a resternotomy and preoperative computed tomography (CT) scans; 755 and 5,872 were in the early and late institution of CPB groups, respectively. Patients were stratified into high (n=563) or low (n=6,064) anatomic risk of re-entry based on CT criteria. Weighted propensity-balanced operative mortality and morbidity were compared with surgeon as a random effect. Results Reoperative procedures most commonly incorporated aortic valve replacement (n=3,611) and coronary artery bypass grafting (n=2,029), but also aortic root (n=1,061) and arch procedures (n=527). Unadjusted operative mortality was 3.5% (235/6,627), and major sternal re-entry and mediastinal dissection injuries were uncommon (2.8%). In the propensity-weighted analysis, similar mortality (3.1% vs 4.5%, P=.6) and major morbidity, including stroke (1.8% vs 3.2%) and dialysis (0 vs 2.6%), were noted in the high anatomic risk cohort between early and late CPB groups. Similar trends were observed in the low anatomic risk cohort (mortality 3.5% vs 2.1%, P=.2. Conclusions Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.