Effect analysis of repeat sternotomy in pediatric cardiac operations

Abstract

BackgroundReoperation for congenital heart disease may be associated with cardiac or vascular injuries during repeat sternotomy, resulting in increased mortality and/or morbidity rates. The aim of this study was to determine the frequency of these cardiac injuries and the associated outcome.MethodsBetween January 2012 and December 2013, 4256 sternotomy procedures were performed at the Pediatric Cardiac Center in Fuwai Hospital, including 195 repeat sternotomy procedures (RS). We retrospectively studied the clinical data of 195 RS patients and 250 randomly selected primary sternotomy (PS) patients. Demographic and operative details, major injures (MI), and clinical outcomes were compared between the two groups. We also assessed the risk factors for major injury and in-hospital mortality and morbidity.ResultsSignificant differences were observed between the RS and PS groups in terms of skin incision to cardiopulmonary bypass(CPB) time, overall CPB time, cross-clamp time and blood requirement, and ventilation time (p < 0.001). MI during RS occurred in 7 of the 195 patients (3.6 %), while operative mortality was 1.0 % (2/195). However, in the RS patients, mortality and morbidity rates were not significantly different between the MI subgroup and the non-MI subgroup (p = 1.000 and 0.556, respectively). Additionally, no significant difference was found between the RS and PS groups in terms of mortality (p = 1.000) and morbidity (p = 0.125).ConclusionsBoth RS and MI are not associated with increased risk of operative mortality and morbidity. Outcomes for reoperative pediatric operations in contemporary practice are similar with those for primary operations.

Heart-Lung Transplant via an Eighth-Time Sternotomy

“…These findings were echoed in 2015 by Yin et al who demonstrated that while CPB time, skin incision to CPB time, ventilation time, cross-clamp time, and blood requirement were all significantly different between primary and redo sternotomies, there was no significant difference in mortality or morbidity. 2 This is consistent with our patient's outcome having an ischemic time of over four hours (258 minutes) and leaving the hospital without complications. At our institution, it is not standard practice to perform 3D imaging of the chest prior to re-sternotomy, though in this patient's case, many imaging studies were available.…”

“…In the pediatric literature, there is strong evidence that in the current era repeat sternotomy is not a risk factor for morbidity or mortality. 1,2 For example, Morales et al studied the incidence of injury and mortality during repeat sternotomy and found no significant difference in occurrence of injury or mortality between primary and redo sternotomies in a series of 602 repeat sternotomies performed in 558 patients. 1 In that series, rates of nonemergent blood transfusion, femoral cannulation, sternal wound infection, and reoperation for postoperative bleeding were all ≤1% with a 98% survival to discharge.…”

Utility of Cervical Cannulation During Difficult Resternotomy in Congenital Heart Surgery

“…Our recent study demonstrated that the risk of major bleeding during resternotomies was 1.8% in 108 patients. 1 Yin et al 6 reported 3.6% major injury during sternal reentry among 195 patients. Our primary choice for peripheral cannulation was femoral vessels.…”

Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

“…Nonetheless, in the last 20 years, this idea has been studied. [2][3][4] One of the first studies on the subject was carried out by Russell et al in 1998, with the conclusion that repeat sternotomy carries minimal added risk. 5 In 2008, Morales et al demonstrated that repeat sternotomy represents a negligible risk of injury and therefore that the choice of management strategies should not be affected by the need of a reoperation.…”