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The timing of cardiac reoperation has no influence on mortality

The timing of cardiac reoperation has no influence on mortality

TOPLINE:

Compared to later cardiac reoperations, early reoperations have increased technical complexity with longer operation times and higher blood transfusion requirements, but have no significant difference in mortality rate.

METHODOLOGY:

  • Researchers conducted this study to examine how the interval between previous cardiac surgeries and subsequent reoperations affects operative mortality and the complexity of associated procedures.
  • These included 6,021 cardiac reoperations with resternotomy performed at Cleveland Clinic from 2008 to 2017; In order for all patients to be included in the study, preoperative CT scans were required.
  • Reoperations included 597 coronary artery bypass grafts (CABGs), 2,557 isolated valve surgeries, 1,743 thoracic aortic surgeries, 954 combined valve and CABGs, and 170 other surgeries.
  • Operative mortality was determined for four time intervals since the previous operation: 15 years.
  • Surgical difficulty was assessed by the duration of the procedure and the amount of blood transfusion required.

TAKE AWAY:

  • Operative mortality was 3.3% in the entire cohort, with no significant difference between early reoperations (3.6%) compared to intervals of 1-5 years (3.1%), 5-15 years (3, 4%) and > 15 years (3.2%). (P = .96).
  • In isolated repeat CABG cases, an increase in mortality was observed within the first year (P = .04); However, the small number of deaths in this group prevented definitive conclusions about the connection, according to the researchers.
  • Early reoperations were associated with increased surgical complexity, longer operative times (median 402 minutes), greater need for intraoperative blood transfusions (77%), and high anatomic risk (12%).
  • Nonelective surgery, lower hematocrit, higher creatinine, higher New York Heart Association functional class, and lower left ventricular ejection fraction were the most common factors associated with operative mortality.

IN PRACTICE:

The results “underscore the need for thorough preoperative planning and risk assessment, particularly for early repeat surgery in patients who have undergone CABG,” the study authors wrote. “By understanding this complexity, experienced surgeons can adapt management strategies, improve outcomes and neutralize the high risk.”

SOURCE:

This study was conducted by Dr. Dr. Richard Ramsingh of the Department of Thoracic and Cardiovascular Surgery at the Miller Family Heart, Vascular & Thoracic Institute of the Cleveland Clinic in Cleveland and published online December 18, 2024 JAMA Surgery.

RESTRICTIONS:

No limitations were reported for the study.

DISCLOSURES:

No funding information was provided for the study. Some authors reported receiving personal fees, consulting, speaking fees, or royalties from various pharmaceutical companies outside of the submitted work, and had other connections to various sources.

This article was created as part of this process using multiple editorial tools, including AI. Human editors reviewed this content before publication.