Surgical Results of Third or More Cardiac Valve Operation.
10.5090/kjtcs.2015.48.1.25
- Author:
Suk Ho SOHN
1
;
Ho Young HWANG
;
Kyung Hwan KIM
;
Ki Bong KIM
;
Hyuk AHN
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea. ahnhyuk@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Reoperation;
Sternum;
Pericardium;
Outcomes;
Valve disease
- MeSH:
Brachiocephalic Veins;
Cardiopulmonary Bypass;
Heart Atria;
Heart Valve Diseases;
Heart Valves*;
Hospital Mortality;
Humans;
Incidence;
Membranes, Artificial;
Mortality;
Pericardium;
Postoperative Complications;
Reoperation;
Sternum
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2015;48(1):25-32
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: We evaluated operative outcomes after third or more cardiac operations for valvular heart disease, and analyzed whether pericardial coverage with artificial membrane is helpful for subsequent reoperation. METHODS: From 2000 to 2012, 149 patients (male:female=70:79; mean age at operation, 57.0+/-11.3 years) underwent their third to fifth operations for valvular heart disease. Early results were compared between patients who underwent their third operation (n=114) and those who underwent fourth or fifth operation (n=35). Outcomes were also compared between 71 patients who had their pericardium open during the previous operation and 27 patients who had artificial membrane coverage. RESULTS: Intraoperative adverse events occurred in 22 patients (14.8%). Right atrium (n=6) and innominate vein (n=5) were most frequently injured. In-hospital mortality rate was 9.4%. Total cardiopulmonary bypass time (225+/-77 minutes vs. 287+/-134 minutes, p=0.012) and the time required to prepare aortic cross clamp (209+/-57 minutes vs. 259+/-68 minutes, p<0.001) increased as reoperations were repeated. However, intraoperative event rate (13.2% vs. 20.0%), in-hospital mortality (9.6% vs. 8.6%) and postoperative complications were not statistically different according to the number of previous operations. Pericardial closure using artificial membrane at previous operation was not beneficial in reducing intraoperative events (25.9% vs. 18.3%) and shortening operation time preparing aortic cross clamp (248+/-64 minutes vs. 225+/-59 minutes) as compared to no-closure. CONCLUSION: Clinical outcomes of the third or more operations for valvular heart disease were acceptable in terms of intraoperative adverse events and in-hospital mortality rates. There were no differences in the incidence of intraoperative adverse events, early mortality and postoperative complications between third cardiac operation and fourth or more.
