The Effect of Repeat Sternotomy during Right Ventricular Outflow Tract Reconstruction

Abstract

Objective Right ventricular outflow tract (RVOT) reconstruction necessitates frequent reoperation. To understand the early outcomes, we analyzed our results to provide the intra‐ and postoperative morbidity and mortality. We hypothesized that multiple previous sternotomies do not influence the morbidity, mortality, or survival. Design We performed a retrospective review of patients who underwent reoperative RVOT reconstruction at the University of Rochester Medical Center and SUNY Upstate Medical Center from January 1, 2000 to December 31, 2009. Patients were divided into three groups based upon the number of previous sternotomies: Group 1 with one, Group 2 with two, and Group 3 with three or more previous sternotomies. Results 220 patients had reoperative RVOT reconstruction, 103 in Group 1, 71 in Group 2, and 46 in Group 3. There was no difference in the percentage of inadvertent cardiotomy between groups (Group 1: 2%, Group 2: 1%, Group 3: 2%; P =.9) The number of previous sternotomies had no effect upon infection, arrhythmia, or the percentage of patients who received a red blood cell transfusion (Group 1: 56%, Group 2: 49% Group 3: 43%; P =.3). Perioperative mortality for the entire group was 3/220 (1.4%), with no difference between groups. At a mean follow‐up of 39 months, there was a survival of 98% for Groups 1 and 3 and 97% for Group 2 (P =.7). Conclusion Reoperative RVOT reconstruction can safely be performed with limited morbidity and mortality. The number of previous sternotomies does not influence the rate of cardiotomy, red blood cell transfusion, or early outcome.

Pulmonary valve replacement after right ventricular outflow tract reconstruction with homograft vs Contegra®: a case control comparison of mortality and morbidity

“…The overall operative complication rate was approximately 14%, even though the patients underwent multiple sternotomies. This rate was not influenced by the type of conduit in place during the redo procedure and this result corroborates with other reports on the fact that, if approached meticulously in specialized centers, repeat sternotomy can be performed with a minor subsequent morbidity and mortality [ 43 , 44 ]. Allografts and xenografts differ in the host immunogenic response, and when implanting a xenograft, one could expect a greater inflammatory reaction.…”

Effect analysis of repeat sternotomy in pediatric cardiac operations

“…Our operative mortality in the RS group compared with the control PS group showed no statistical difference (1 % versus 0.8 % , p = 1.0 ), which was consistent with Morales’ [ 3 ] report that showed RS was not a risk factor of pediatric cardiac operative mortality. The Kirshbom study [ 4 ] reported that mortality was associated with the number of sternotomy procedures, while the Swartz study [ 5 ] reported that increasing number of previous sternotomies does not increase the overall morbidity and mortality in some patients. Our data also showed the mortality was not associated with the number of sternotomy procedures, but we only had 7 s RS patients.…”

A Novel Designed Valved Conduit for RVOT Reconstruction in Grown-up Congenital Heart Patients: a Glimpse Down the Road

“…18 Consequently, this patient cohort requires multiple reinterventions during their lifetime. 19 Although a plethora of pulmonary valves and valved conduits are available, the search for an ideal conduit is ongoing. 2,[20][21][22] In the late 1960s, Ross and Somerville described RVOT reconstruction for the first time with an aortic homograft.…”