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At least 325 records · Page 18Linked to original sources
PubMed2002

Beating heart surgery reduces mortality in the reoperative bypass patient.

BACKGROUND: Reoperative coronary artery bypass grafting (redo-CABG) has an increased operative morbidity and mortality compared to patients undergoing primary revascularization. In an effort to reduce the hazards of reoperative CABG, we commenced revascularizing selected patients without cardiopulmonary bypass (CPB) as an alternative to conventional approaches. METHODS: From January 1998 to Dec. 2000, 432 patients underwent reoperative CABG, 153 patients (35%) without the aid of CPB. Treatment groups were compared by means of univariate analysis for preoperative risk factors and postoperative complications. Predicted risk and risk-adjusted mortality were determined by the Society of Thoracic Surgeons risk algorithm. RESULTS: There was a significant difference in the preoperative predicted risk scores between the two treatment groups (off pump 6.5% vs. on pump 5.4%, p=0.0343). There was a significant difference in the off pump observed mortality (2.61%) versus the on pump group (9.68%, p=0.0065). Decreased morbidity in the off pump group was evidenced by a reduced need for blood products (25% vs. 67%, p<0.0001), and the incidence of prolonged ventilation (4% vs. 14%, p=0.0032). The off pump group also had shorter hospital stays (6.2 +/- 5.96 days vs. 8.0 +/- 7.82, p=0.0091). No significant differences between the two groups were seen in the prevalence of perioperative myocardial infarction, stroke, renal failure, or reoperation for bleeding. CONCLUSION: Bypass grafting without CPB significantly decreases mortality and morbidity in selected reoperative patients, and should be considered a viable alternative to conventional approaches.

Analysis of Variance↗
PubMed2003

[The reason and prevention of upper cervical reoperations].

OBJECTIVE: To discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease. METHODS: Thirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations. RESULTS: The reasons for reoperations included 9 cases with unstable or re-dislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital-cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone-plant slipped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom. CONCLUSIONS: The common reasons for upper cervical reoperations were due to instability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.

Adolescent↗
PubMed2003

[Femoro-popliteal reocclusion. Obligatory reoperation?].

The paper presents 408 cases of femoro-poptiteal reocclusion. The effectiveness of 202 reoperations is analyzed. Authors give definition of repeated operations and restitution of secondary patency in femoro-popliteal segment. Repeated operation is a special entity differing from initial one and including graft exchange, occasionally of the same construction. Secondary patency is a restitution of blood flow without graft or operation type exchange. Effectiveness of reoperations appeared to depend on initial intervention type, timing and grade of lower limb ischemia. The analysis of this correlation served the basis for development of reoperation indications, decision algorithm for reoperation type, timing and graft material. The validity and effectiveness of second or further reoperations are reviewed. The relation of limb salvage rate in femoro-popliteal reocclusions and both surgical and conservative management strategies is driven.

Algorithms↗
PubMed1992

[Reoperation for recurrent gliomas].

Twenty-three cases of recurrent gliomas were reoperated upon. The indications and some factors influencing the length of survival time after reoperation were studied. It was found that reoperation is important in the management of recurrent gliomas, but strict indications must be followed with special attention to prevent CSF leakage, breaking and infection of the incision. Reoperation is not only to prolong life time but also to improve living quality. After reoperation, a comprehensive treatment is needed.

Adult↗
PubMed2005

Reoperations on the ascending aorta and aortic root. Early and late results?

AIM: We have retrospectively evaluated our results after aortic root and ascending aorta reoperations to determine risk factors of early death and late mortality. METHODS: From January 1986 to April 2002, 73 patients underwent ''reoperative'' procedures on the aortic root and the ascending aorta. The mean age was 56.1+/-13.4 years and males numbered 62 (84.9%). The most frequent indication for reoperation was degenerative aortic aneurysm (49.3%) followed by post-dissection aneurysm (11%). Aortic root replacement with composite valve graft was performed in 47 patients (64.4%) and with aortic homograft in 2 (2.7%). Nineteen patients (26%) underwent ascending aorta replacement with tubular graft, and 4 (5.5%) underwent tailoring aortoplasty of the ascending aorta. RESULTS: The 30-day mortality rate was 16.4% (12 patients). Mortality following elective operations was 8%, and that following urgent or emergency operations was 34.8% (p=0.002). Late survival of hospital survivors at 1, 5 and 10 years was 93.8%, 77.7% and 37%, respectively. In the multivariate Cox regression analysis chronic renal failure (p=0.003) and urgent or emergency operation (p=0.018) were found to be independent predictors of late mortality. CONCLUSIONS: Reoperations on the ascending aorta can be accomplished with acceptable early mortality and satisfactory long-term RESULTS: More radical treatment of the aortic pathology at the initial operation may reduce the need for further reoperations. A careful follow-up is extremely important for detecting complications of the first operation or progression of the aortic pathology before an emergency operation, predictive of poorer early and late outcome, is needed.

Adult↗
PubMed2005

Mitral valve reconstruction: experience related to early and late mortality and reoperation.

BACKGROUND AND AIM OF THE STUDY: The present authors' experience with mitral valve reconstruction was reviewed to determine the influence of anatomical and functional abnormalities on mortality and reoperation. METHODS: Between 1991 and 2001, a total of 397 patients (mean age 59.0 +/- 13.4 years) underwent mitral valve reconstruction at the authors' institution. Patients were grouped according to the Carpentier functional classification as follows: type I, n = 88 (mean age 57.4 years; range: 24-81 years); type II, n = 169 (mean age 59.8 years; range: 16-81 years); type IIIa, n = 44 (mean age 52.8 years; range: 22-78 years); type IIIb, n = 85 (mean age 65.1 years; range: 33-82 years); and congenital (C), n = 11 (mean age 36.2 years; range: 18-65 years). RESULTS: The total follow up was 1,485.8 patient-years (pt-yr). Early mortality was: type I, 3.4% (n = 3); type II, 0; type IIIa; 2.3% (n = 1); type IIIb, 9.4% (n = 8); and C, 0 (p = 0.0028, IIIb > II and C). The late mortality was: type I, 2.1%/pt-yr (n = 6); type II, 1.1%/pt-yr (n = 7); type IIIa, 1.8%/pt-yr (n = 4); type IIIb, 4.3%/pt-yr (n = 12); and C, 1.7%/pt-yr (n = 1) (p = 0.0035 IIIb > II). The overall survival at 10 years was 79.6 +/- 4.2% (p <0.001, II > IIIb; p = 0.029, I > IIIb; p = 0.046, II > I). The reoperations were: type I, 1.4%/pt-yr (n = 4); type II, 1.9%/pt-yr (n = 12); type IIIa, 0.9%/pt-yr (n = 2); type IIIb, 0.4%/pt-yr (n = 1); and C, 0 (p = 0.0435 II > IIIb). Among the 19 reoperations there were 17 replacements, one re-repair, and one annuloplasty. The failures were predominantly type II, posterior (n = 5) and anterior (n = 5), or a combination (n = 2). The overall freedom from reoperation was 92.0 +/- 2.2% (p = NS between groups). CONCLUSION: Mitral valve reconstruction can be performed in all four functional categories with generally satisfactory results, except possibly for functional ischemic disease. The results of surgery for degenerative disease afford the opportunity for early surgical management, if proven techniques are adhered to in order to minimize the risk of reoperation. The repair of ischemic disease due primarily to ventricular dysfunction is in a state of evolution.

Adult↗
PubMed2005

Reoperations for aortic aneurysm after the Ross procedure.

BACKGROUND AND AIM OF THE STUDY: Among late complications after the Ross operation, autograft dilatation is likely the most common. In order to define prevalence, consequences and management of autograft dilatation, a 10-year clinical experience was reviewed. METHODS: A total of 112 patients (mean age 29 +/- 10 years) underwent cross-sectional echocardiographic follow up. End-points of the study were freedom from autograft dilatation (diameter >4 cm, indexed as 0.21 cm/m2) and from reoperation for dilatation. Risk factors for autograft dilatation were also identified. RESULTS: There were 110 late survivors; average follow up was 5.1 +/- 1.9 years (range: 0.3 to 10.6 years). At 10 years, autograft dilatation was identified in 32 patients (29%), compatible with aortic aneurysm (>5.0 cm) in seven patients (6%). Seven of 32 patients (22%) presented moderate or greater autograft insufficiency. Ten-year freedom from dilatation was 43 +/- 8%, and from regurgitation was 75 +/- 8%. At multivariate analysis, preoperative aneurysm (p = 0.02), root replacement technique (p = 0.03) and absence of root buttressing (p = 0.04) were predictive of dilatation. Reoperation for autograft aneurysm was performed in five patients at a mean of 7.3 +/- 0.8 years after the Ross procedure, while two patients await reintervention. Two patients had root replacement and three remodeling with valve preservation (two root replacements, one sinotubular junction replacement): all survived reoperation. Ten-year freedom from root reoperation was 81 +/- 6%, and from full root replacement was 94 +/- 2%. CONCLUSION: With increasing follow up after the Ross operation, the incidences of root dilatation and reoperation are likely to rise. Graft replacement of coexisting aneurysm, avoidance of root replacement technique and the use of root-stabilization measures may reduce the prevalence of late root pathology. Early replacement of dilated autograft roots may allow preservation of the autologous pulmonary valve.

Adult↗
PubMed1991

Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery.

We performed a case-control study to estimate the relative risk of reoperation for bleeding in coronary artery bypass graft patients who had taken aspirin within the 7 days preceding surgery. Comparison of 90 cases of reoperation with 180 matched control subjects gave an estimated odds ratio for reoperation of 1.82 (95% confidence interval, 1.23 to 3.32). Although their preoperative coagulation values were similar, cases used significantly more whole blood (cases, 9.5 +/- 5.2 units; control subjects, 3.0 +/- 2.0 units; median +/- interquartile range), packed red blood cells (cases, 2.1 +/- 4.0 units; control subjects, 0.9 +/- 2.0 units), and platelets (cases, 12.2 +/- 12.0 units; control subjects, 2.9 +/- 4.0 units) than control subjects. Cases had intensive care unit stays of 4.7 +/- 5.7 days (mean +/- SD) vs 2.1 +/- 1.9 days for control subjects and postoperative hospitalizations of 10.9 +/- 8.2 days vs 7.0 +/- 3.2 days for control subjects. We conclude that aspirin exposure within 7 days before coronary bypass surgery is associated with an increased rate of reoperation for bleeding and that reoperation is associated with large increases in transfusion requirements and intensive care unit and hospital stays.

Aspirin↗
PubMedDate not supplied

Reoperation-free survival after closed mitral commissurotomy. A 28-year follow-up study in 469 patients.

We evaluated the long-term results in 469 patients who underwent closed mitral commissurotomy (CMC) between 1952 and 1972, and analyzed actuarial and reoperation-free survival rates together with the recurrence of symptoms necessitating reoperation after CMC. There were 36 operative deaths (7.6%) and 167 late deaths (36.8%) including 40 deaths following reoperation. One hundred and twenty patients (26%) required reoperation a mean of 13.8 years after CMC, with a range of one to 27 years. The actuarial survival rates were 75%, 58% and 38% at 10, 20 and 28 years after surgery, respectively. The reoperation-free survival rates were 70%, 42% and 15% at 10, 20 and 28 years, respectively. Untreated subvalvular changes and inadequate commissurotomy were definite factors adversely influencing the long-term results.

Actuarial Analysis↗
PubMed1989

[Surgical treatment of the prosthetic valves in reoperation].

Surgical treatment and problems in patients required reoperation for malfunctioning prosthetic valves are reviewed in our institute. The cinefluoroscopy and pulse doppler echocardiography were helpful for diagnosis of artificial valve dysfunction. In recent two decades valve replacement were performed in 382 cases and number of re-implanted valve were 469. Among them the cases of reoperation were 21 and reimplanted valves were 25 (5.6%); 4.7% in aortic, 5.0% in mitral, 6.7% in tricuspid position. Three cases of those patients had three operations. Main causes of reoperation were primary tissue failure in Carpentier-Edwards porcine xenograft (6 cases, 23%) and cloth wear in Starr-Edwards ball valve (9 cases, 38%) and thrombosis in St. Jude Medical bi-leaflet valve (3 cases, 15%). In most cases St. Jude Medical valve were chosen for the alternative prosthetic valve in reoperation. We applied IABP support to seven patients for severe low cardiac output syndrome after the operation and overall mortality was 24% in reoperation. It concluded that St. Jude Medical valve may be most reliable because of low incidence of postoperative complication in our institute.

Adult↗
PubMed1989

Diagnostic procedure before reoperation in patients with medullary thyroid carcinoma.

Elevated calcitonin (CT) levels after primary operation of the medullary thyroid carcinoma (MTC) are a reliable marker for persistence or recurrence of MTC, which first metastasizes in the neck or mediastinal region. The reliability of different localisation methods before reoperation in 28 patients with elevated CT levels was tested by comparing their diagnostic results with the actual finding at reoperation. The diagnostic procedures comprised ultrasonography of the neck, CAT-scan of the neck and mediastinum, selective venous catheterization with CT determinations, and fine needle biopsy. Due to the results of these tests 28 patients were reoperated 48 times. Histological evidence confirmed the presence of suspected tumor that had been diagnosed by: palpation 52%, ultrasonography 78%, CAT-scan 70%, selective venous catheterization 75%, fine needle biopsy 81%. Despite the fact that only 2 out of the 28 patients had normal CT levels postoperatively, the 5 year survival rate in reoperated patients (86%) improved compared to patients without reintervention (69%). For precise preoperative staging ultrasonography seems to be the most predictable and reliable method. The prognosis of MTC patients with elevated CT-levels in the follow-up period could be improved by frequent reoperations.

Adult↗
PubMed1989

[A study on selection of operative technique for chronic empyema based on findings obtained from reoperated cases].

In 13 patients undergone reoperation for chronic empyema during 9 years period from 1975 to 1983, the operative technique employed for the initial treatment, number of operations, findings of fistula and residual cavity and complications associated with each technique were reviewed with following results. Among these reoperated patients, the initial operation was thoracic cavity reduction in 5 cases, pulmonary detachment in 6 cases and air-plombage (Kinchu method) in 2 cases. Reoperation was carried out in a total of 27 times. There were 6 cases (46%) which were operated more than 3 times. These 6 cases included none of the cases which underwent air plombage. At the time of the first reoperation, fistula was observed in 11 out of 13 cases. At the final operation the residual cavity was accompanied with fistula in 7 cases and empyema in 5 cases. As the final operation, chest wall plombage chiefly by a modification of Grow's method combined with pedicle muscle plombage was employed. In cases indicated for more than two times of operations of thoracic cavity reduction, chest wall plombage was useful for reoperation. On the basis of these results, indication of each operation to improve results of surgical treatment of chronic empyema was discussed by taking into consideration advantages and complications of each operative technique.

Adult↗
PubMed1987

Results of reoperation for failure of cardiac bioprostheses.

A ten-year experience with reoperations for failure of cardiac bioprostheses is reported. 362 patients were operated for valve replacement with 412 bioprostheses. There were 35 (9.64%) reoperations for valve failure. Mean time between operation and reoperation was of 64.4 months. Operative mortality was 14.28%: 3 patients died for cardiac and 2 for extra-cardiac causes. Long-term mortality after reoperation was 6.25%. Morphological examination of the explanted bioprostheses confirmed the cause of bioprosthetic valve failure, due to calcific degeneration in 88.88% of case, to post-endocarditic rupture in 5.55% and to prosthetic thrombosis in 2.77%. The importance of timing reoperation is stressed in order to reduce the operative mortality. The conditions suitable for implantation of bioprostheses are listed.

Adolescent↗
PubMed1986

[Risk of reoperations and acute interventions in valvular surgery].

Reoperations in valvular surgery can be subdivided into procedures following reconstructive measures (group A) and interventions following implantation of a valve prosthesis (group B). In group A (valve replacement after conservative mitral surgery, 41 cases from 1976 to 1984 in our institution), operative mortality does not significantly differ from patients undergoing primary isolated mitral valve replacement (7.3% v. 4.4%). In group B, however, the risk of prosthetic valve reoperation mainly depends on the morphological alterations implying the surgical intervention. Among these conditions, prosthetic valve endocarditis has the poorest prognosis (operative mortality 25% in our own experience), especially if an emergency intervention is mandatory as a result of severe heart failure. In contrast to this high risk group, patients being reoperated on an elective basis due to paraprosthetic leakage or recurrent arterial embolism, do not show a higher risk when compared to first procedures. The risk of emergency surgery on native heart valves is discussed under the consideration of patients suffering from acute infective endocarditis (AIE). As in reoperations, the preoperative cardiac functional status and the urgency of the surgical intervention are the principal determinants for the operative risk. Both for reoperations and emergency procedures surgical timing is of great importance in the management of valvular patients; when ever possible, surgery should be carried out before the development of advanced ventricular failure necessitates an intervention under emergency conditions.

Aortic Valve↗
PubMed1985

Surgical repair of tetralogy of Fallot. Long-term follow-up with particular emphasis on late death and reoperation.

Early and late results in 309 patients undergoing repair of tetralogy of Fallot between 1960 and 1982 were analyzed with respect to independent determinants of operative mortality, late reoperation, and late death. Follow-up extended to 22 years and totaled 2,743 patient-years. The operative mortality rate was 4.9% +/- 1.3%. Multivariate logistic regression analysis revealed that only young age, long cardiopulmonary bypass time, and (probably) extent of right ventricular outflow tract patch were independent significant determinants of operative mortality. Patients who required a transannular right ventricular outflow tract patch and those who underwent repair without any outflow tract patch were at higher risk than those who received a separate right ventricular and/or pulmonary artery patch. The long-term results were highly satisfactory: Only 15% +/- 3% of patients required reoperation 13 years postoperatively, and 85% +/- 4% of discharged patients were alive 16 years later. Time-dependent linear stepwise multivariate discriminant analysis showed that extent of right ventricular outflow tract patch (transannular greater than none greater than right ventricular and/or [separate] pulmonary arterial), longer ischemic arrest time, previous palliative shunt, and primary suture closure of the ventricular septal defect were the only covariates that independently portended a higher likelihood of reoperation. Similarly, only older age, absence of hypoxic spells, and reoperation were significantly and independently related to the probability of late death. The results of these analyses demonstrate that intracardiac repair of tetralogy is a durable procedure for upwards of 20 years; however, high-risk subsets of patients can be identified in terms of operative mortality, reoperation, and late death. Thus, there is still a need for improvement, particularly future research devoted to better understanding of the electrophysiological mechanisms responsible for arrhythmias, electrosurgical and medical arrhythmia therapy, and right and left ventricular mechanics after repair of tetralogy of Fallot.

Actuarial Analysis↗
PubMedDate not supplied

Reoperation after initial correction of tetralogy of Fallot.

Ten of 357 patients (2.8%) who had total correction of tetralogy of Fallot in our institute between 1955 and 1983 required intracardiac reoperation. The indication for reoperation included residual lesions alone or in combination with other lesions. The reoperation consisted of a new patch closure of a residual ventricular septal defect in nine, reconstruction of a residual right ventricular outflow tract obstruction in five, repair of a left ventricle-right atrium communication in two, repair of tricuspid insufficiency in two and closure of an atrial septal defect in one. None of these ten patients had died at early or late follow-up periods (mean 5.3 years) or required further reoperation. A patient who has one or two of the following criteria, which are surgically correctable, and who would face deterioration in symptomatic status without surgical intervention is a candidate for reoperation: (1) Qp/Qs greater than 1.5, (2) Systolic pressure gradient between RV and PA greater than 50 mmHg, (3) Mean RA pressure greater than 20 mmHg, (4) CTR greater than 65%, (5) NYHA class III or IV.

Adolescent↗
PubMed1984

[Reoperation following correction of partial defects of the endocardial cushion (indication, incidence, results)].

In the period between 1955 and 1982, 297 patients underwent surgical correction of a partial AV-canal. Closure of the ostium primum defect was performed either by direct suture or by patch (prosthetic material or pericardium). Only in cases with severe mitral incompetence was the cleft in the anterior leaflet of the mitral valve surgically treated. At an average of 6 years (range: 3 months - 22 years) after the initial procedure 21 patients (7.8 per cent) underwent reoperation. In 20 patients reoperation was necessary for hemodynamic reasons (recurrence of ASD: n = 8; severe AV-valve regurgitation: n = 3; or both: n = 9). One patient with moderate mitral valve incompetence suffered from severe "patch-hemolysis" due to direction of the blood-jet towards the prosthetic patch. Residual or recurrent atrial septal defects were closed by using a patch in cases with previous direct suture (39 patients - 8 reoperations) or by reinsertion or enlargement of the present patch (258 patients - 13 reoperations). AV-valve incompetence could be treated in all cases but two with reconstructive methods. In two patients implantation of a prosthetic valve was necessary. In the single case with "patch-hemolysis" the previous prosthetic patch was replaced by a pericardial one, together with a suture of the mitral cleft 3 months after operation. Mortality of reoperation was 14.5 per cent (3 early deaths). Major complications in the surviving patients did not occur, with one exception: one patient with postoperative total AV-block received a permanent pacemaker.

Adolescent↗
PubMed1995

Reoperative coronary artery bypass surgery: early and late results and management in 1300 patients.

In this retrospective series overall results after reoperative coronary artery bypass surgery and the subsequent management of recurrent ischemic heart disease in these patients were reviewed. Between September 1980 and September 1993, 17% (n = 1300) of our patients (Pts) undergoing myocardial revascularization (CABG) were reoperative. Of these, 75% were male and 17% were > or = 70 years. One or both internal thoracic arteries (ITA) were used in 25% Pts; a saphenous vein graft (SVG) was used sequentially in 67% or as a separate conduit in 8%. Hospital mortality was higher after redo CABG than after primary CABG (6.9% vs 2.1%, p < 0.0001) and also in Pts receiving SVG rather than IMA as a conduit (7% vs 3.8%, p < 0.001), and in Pts receiving retrograde coronary sinus cardioplegia (RCSC) (n = 504) as compared to those who received antigrade cardioplegia since 1989 (n = 334) (2.5 vs 5.4%, p < 0.05). Throughout the series, independent predictors of hospital mortality by multivariate analysis were: female gender, postoperative myocardial infarction, congestive cardiac failure and stroke. Actuarial survival at 10 years for the patients receiving ITA as a conduit was 86% and for the patients receiving SVG only 76% (p < 0.02); for patients > 70 years was 66% and for patients < 70 years 80% (p < 0.005). Pts with a LVEF < 20% had a poor survival after 2 years. At 10 years cardiac related event free survival after 1st reoperation was 53%. During 13 years 94 Pts underwent subsequent reoperations and 125 Pts underwent saphenous vein graft angioplasty (PTCA), for recurrent ischemic heart disease. Cardiac event free survival at 6 years was clearly superior after multiple reoperative surgery than after graft angioplasty (45% vs 35% p < 0.05). In conclusion, in this series, use of the ITA as a conduit and RCSC has significantly improved Pts survival after redo CABG. Survival and quality of life were further improved in patients requiring multiple reop CABG or graft PTCA.

Age Factors↗