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At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

Coronary artery reoperations using arterial conduits: immediate and early results.

This study deals with results of coronary artery reoperations in 21 males aged 54.4 +/- 6.6 years. Native vessel coronary disease at first and second operation was nearly the same (2.7 +/- 0.6 vs 2.8 +/- 0.4 vessel, p = NS). Graft attrition and deterioration in left ventricular ejection fraction (55.9 +/- 9.2 initial vs 36 +/- 15 at reoperation, p < 0.001) necessitated reoperation in majority. Recurrence of angina (71%) and left ventricular failure (23.8%) were the clinical indicators for reoperation. Procedure was successful in 20 (95%) and had to be abandoned in 1 due to severe pericardial and sternal adhesions. Arterial grafts were utilised in 90% (18 cases, Group A and B). Total arterial revascularisation (Group A) was done in 9 (45%) using Y graft 6, combination of both mammary arteries 2, and by both mammary and inferior epigastric artery in 1. Group B patients had arterial grafts (bilateral IMA 1, Y graft 1, bilateral IMA + gastroepipolic 1, RIMA 4, and LIMA 2) in addition to a venous graft. Two patients (group C, 10%) had only venous grafts. There was no in hospital mortality or morbidity and at 10 +/- 5.2 months follow up, all are asymptomatic with negative stress test at 3 months followup in 8 cases. We conclude that coronary artery reoperations using arterial conduits can be performed safely with excellent immediate and early results.

Angina Pectoris↗
PubMed1993

[Coronary reoperations: indications and results].

The aim of this study was to assess the results of coronary reoperations and to determine the indications. Between January 1972 and December 1990, 166 coronary reoperations were performed in 161 patients (5 patients were operated three times). The interval between the first and second operation was 93 +/- 46 months. The interval between recurrence of symptoms and reoperation was 27 +/- 40 months. Recurrence of symptoms was related to isolated problems with the bypass grafts in 23% of cases, to an aggravation of the coronary disease without problems with the bypass grafts in 17% of cases and to an association of the two conditions in 60% of cases. Mortality in the first 30 postoperative days was 7.8% (13/161). The predictive factors of mortality were age over 70 years and an interval between recurrence of symptoms and reoperation of over 12 months. The causes of death were myocardial infarction (n = 5), left ventricular failure (n = 4), sudden death (n = 3), and arrhythmias (n = 1). The average follow-up period of survivors (n = 134) was 40 +/- 32 months. Four patients have been transplanted. Seven patients died secondarily. The cause of death was cardiac in 4 cases and non-cardiac in 3 cases. The actuarial 5 year and 10 year survival rates were 85 +/- 3%. Actuarial absence of myocardial infarction, angina, Class III-IV cardiac failure and transplantation was 87 +/- 4% at 5 years and 69 +/- 10% at 10 years. These figures show that coronary reoperation gives good functional results and long-term survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Long-term follow-up of patients undergoing reoperation for recurrent carotid artery disease.

PURPOSE: We examined the perioperative course and long-term fate of individuals who required reoperation for recurrent carotid artery disease. METHODS: The records of 2289 patients undergoing 2961 consecutive operations during a 22-year period were reviewed. Forty-two patients (1.8%) who underwent reoperations were studied. Forty-seven redo carotid artery reconstructions were performed on these 42 patients for neurologic symptoms or asymptomatic high-grade stenosis. Long-term follow-up was obtained on 41 of 42 patients (mean 54 months; range 9 to 202 months). RESULTS: The forty-seven reoperations consisted of endarterectomy with patch angioplasty (n = 36), saphenous vein or polytetrafluoroethylene interposition graft (n = 7), or simply vein or polytetrafluoroethylene patch angioplasty (n = 4). There were no perioperative strokes or deaths. Three patients had perioperative transient ischemic attacks and two had cranial nerve injuries. The incidence of late failure after secondary surgery was 19.5% (8/41 patients). These failures consisted of one stroke, three transient ischemic attacks, and four asymptomatic occlusions. One tertiary carotid artery reconstruction was performed for a restenosis at the site of the secondary reconstruction. CONCLUSION: The factors responsible for the high incidence of late failures after secondary carotid artery reconstruction are unclear. Reoperation for recurrent carotid artery disease appears less durable than primary carotid endarterectomy. Close postoperative surveillance is recommended after carotid artery reoperation.

Adult↗
PubMed1993

The value of reoperation for recurrent glioblastoma.

To determine the value of reoperation alone (no further surgical procedures or radiotherapy), 43 patients (27 men, 16 women) with recurrent supratentorial glioblastomas who underwent a second craniotomy for recurrent tumour were reviewed retrospectively. The patients ranged in age from 27 to 66 years (median 53 years). All patients were treated initially by surgical resection and external radiation (50 Gy in 25 fractions through parallel opposed regional fields). In addition, 10 patients (23%) received chemotherapy, 3 patients (7%) received photodynamic therapy and 9 patients (21%) received interstitial brachytherapy postoperatively. Although none of the patients had further surgical procedures or radiotherapy after reoperation for tumour recurrence, 5 of the 43 did receive single-agent chemotherapy. The median survival after the first operation was 57 weeks. The median interval between first and second operations was 32 weeks. Median survival after reoperation was 19 weeks. An interval of more than 50 weeks between the two operations correlated with a significant (p < 0.05) increase in survival. The death rate for reoperation was 4.6%. The infection rate was 9.3%. The authors conclude that reoperation alone confers a modest but valuable increase in survival, especially if the interval between operations is greater than 50 weeks.

Adult↗
PubMed1995

[Reoperation for coarctation of the aorta and interrupted aortic arch].

This report presented four patients who underwent surgery for restenosis after repair of coarctation of the aorta (CoA) or interrupted aortic arch (IAA) at our institution between January 1980 and October 1994. Case #1 underwent primary repair for IAA, VSD, and PDA consisting of aortic arch reconstruction using a EPTFE (expanded polytetrafluoroethylene) graft of 10 mm in diameter at the age of four years. After 17 years, pressure gradient of 58 mmHg between the ascending aorta and the descending aorta prompted the reoperation. Case #2 underwent primary repair for CoA, VSD, and PDA consisting of a bypass between the ascending aorta and the descending aorta with an EPTFE graft of 11 mm in diameter at the age of three years. After 13 years, he had reoperation because of pressure gradient of 64 mmHg. Case #3 had pressure gradient of 20 mmHg between the upper and lower limb at the hospital discharge following patch angioplasty for CoA at five years of age. He underwent unsuccessful percutaneous transluminal balloon angioplasty at age 12 and had reoperation at age 15. Case #4 underwent subclavian flap angioplasty as the first stage operation for CoA, VSD, and PDA at 1 month after birth. About 9 months after the initial operation, the pressure gradient between the upper and lower limb had reached 40 to 50 mmHg, and the patient had reoperation at the age of 1 year. The reoperation method for cases #1, #2 and #3 consisted of bypass grafting from the left subclavian artery to the descending aorta under a simple cross clamping of the thoracic aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

[Coronary reoperation--selection of conduit material and management of stenotic vein graft].

We have operated upon 30 cases of coronary reoperation during the past 12 years. The mean interval between the two operations was 46 months. The mean follow-up after reoperation was 61 months. The major reasons for reoperation were graft failure from technical problems in early and time-related degeneration in graft and native coronary progression in late cases. We aggressively have replaced the stenotic and obstructed vein graft with the arterial graft at reoperation since 1990. Hypoperfusion syndrome is clinical entity reported secondary to inadequate flow via the internal thoracic artery. For patients with atherosclerotic vein grafts to the LAD, the minimal manipulation of the old vein graft, adding the IMA graft to the LAD and leaving the stenotic vein graft intact appear to be safe and better procedure for long-term results. There were no operative and hospital death. Five and 10 years survival rate were 100% and 90% respectively. Five and 10 years event free rate were 92.1% and 82.9% respectively. The outcome of reoperation was satisfactory.

Adult↗
PubMed1996

Reoperation for recurrent thymoma: experience in seven patients and review of the literature.

The authors analysed retrospectively seven patients who underwent reoperation for recurrent thymoma. Patients have been categorised according to the classification of thymic epithelial tumours proposed by Masaoka et al. (29). In addition, patients have been subgrouped according to pleural invasion as defined by Haniuda et al. (15). Thus three substages were proposed as follows: p0-no adhesion to the mediastinal pleura; p1-patients with fibrous adhesion to the mediastinal pleura without microscopic invasion; p2-patients with microscopic invasion into the mediastinal pleura. At the initial operation, two patients were in Stage I, four Stage II, and one in Stage III. All Stage I patients were classified as p1, and of the four patients in Stage II one was classified as p0 and three patients as p2. One Stage III patient was classified as p2. Disease-free survival ranged from two years and four months to 20 years and two months. All patients underwent reoperation without preoperative treatment. Recurrent disease was aggressively resected from the pleura in six patients, mediastinum in four patients, lung in three patients, and diaphragm in three patients. Two patients refused further postoperative treatment. Adjuvant radiotherapy was administered to five patients; chemotherapy was added to the postoperative treatment of three patients with more advanced recurrent disease. Five patients were alive, free from any detectable tumour recurrence, one year and nine months to five years and four months after reoperation. In two patients with exacerbation of myasthenia gravis, reoperation was followed by complete remission of myasthenic symptoms. One patient died of post-radiation pulmonary fibrosis 13 months after reoperation, and one patient died of disease two years and two months after the second operation. Our findings indicate that an aggressive surgical approach to recurrent thymoma is justified and can be followed by prolonged disease-free survival.

Adult↗
PubMed1997

Early localization and reoperation for persistent primary hyperparathyroidism.

BACKGROUND: Reoperation for persistent primary hyperparathyroidism is often performed after a delay of 4-6 months. Success can be expected in over 90 per cent of cases but exploration is technically difficult and there is the possibility of creating permanent hypoparathyroidism and vocal cord paralysis. This is a study of early localization and reoperation. METHODS: In a consecutive series of 273 patients who had surgery for primary hyperparathyroidism, three remained hypercalcaemic and in three the abnormal parathyroid was not found at initial exploration. They underwent early (6-48 h) single-tracer 99mTc Sestamibi scintigraphy with factor analysis of dynamic structures (FADS) and single photon emission computed tomography (SPECT) followed by reoperation within 24-72 h. RESULTS: Scintigraphy with FADS and SPECT was helpful in all six patients, who were cured by reoperation with no morbidity or symptomatic hypocalcaemia. CONCLUSION: Reoperation for persistent primary hyperparathyroidism is possible and may be easier within days of an initially unsuccessful procedure. With the intact 1-84 parathyroid hormone measurement, the diagnosis is accurate. Single-tracer 99mTc Sestamibi scintigraphy with FADS and SPECT is non-invasive, easily and rapidly performed, and was accurate in these six patients.

Chronic Disease↗
PubMed1997

Is aprotinin indicated for reoperative valvular surgery?

BACKGROUND AND AIMS OF THE STUDY: While the hemostatic effect of aprotinin for patients undergoing reoperative coronary bypass is well established, it remains unclear whether these effects extend to patients undergoing reoperative valvular surgery. METHODS: We examined our experience with 85 consecutive patients undergoing isolated reoperative valvular surgery with and without use of perioperative aprotinin in order to investigate differences in perioperative blood use, blood loss, bleeding complications, mortality and incidence of myocardial injury. RESULTS: Aprotinin recipients benefited from a significant reduction in bleeding complications, and a decrease in perioperative and in-hospital mortalities as compared with untreated patients. Anaphylactic reactions and clinically significant thromboembolic events were not observed. There was no difference in the incidence of renal dysfunction or myocardial injury among aprotinin-treated and untreated groups. CONCLUSIONS: Our results indicate that aprotinin therapy can be safely administered to patients undergoing reoperative valvular surgery. No increased incidence of anaphylactic reactions, renal dysfunction or perioperative myocardial injury was noted. The observed reductions in bleeding complications and perioperative and in-hospital mortality strongly warrant the evaluation of aprotinin for reoperative valvular surgery in a prospective fashion.

Adolescent↗
PubMed1994

[Reoperation and PTCA after coronary artery bypass graft].

Since 1984, 1410 patients underwent coronary bypass grafting at Juntendo University Hospital. At the primary operation 797 patients had internal thoracic artery (ITA) graft and 613 patients received only saphenous vein graft (SVG). Reoperation was done in one pt. in ITA group and 10 pts. in SVG group. There were 2 deaths (reoperative mortality 18%). Percutaneous Transluminal Coronary Angioplasty to stenotic SVG was applied to 71 lesions in CABG patients. The primary success rate was 81.7% and restenosis rate was 38.9%. Urgent reoperation was performed on 3 pts. who had PTCA to diseased LAD or stenotic SVG to LAD. Reoperation is technically demanding and is associated with high mortality. Balloon angioplasty may provide a suitable alternative. But high restenosis rate (especially acute stenosis) remains a significant problem, particularly in the pts. with diseased LAD or stenotic vein graft to LAD. Reoperation is another option to relieve the ischemic symptoms in pts. with diseased LAD or stenotic vein graft to LAD.

Adult↗
PubMed1998

Thyroid reoperations: indications and risks.

Thyroid reoperations can be technically difficult and associated with an increased risk of complications. To determine the indications for reoperations and the risk of postoperative complications with these procedures, records of 362 patients undergoing thyroidectomy by a single surgeon (R.A.P.) were reviewed. Thirty-two patients had a reoperation. The group consists of 21 women and 11 men with an average age of 55 years (range, 31-79). Twenty-four patients had 1 prior operation, and 8 patients had 2 or more. We performed 4 of the initial operations, and 28 were done by surgeons at other centers. Fourteen reoperations were done for symptomatic multinodular goiter (MNG), and 5 because of a change in the histologic diagnosis from benign to cancerous. The remainder were for further treatment of malignancy. The most common operation was completion thyroidectomy (31). In 3 patients, either unilateral or bilateral modified radical neck exploration was performed. One patient required median sternotomy. One subtotal thyroidectomy was also performed. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another, who had 3 operations for MNG. One of the 2 patients with preoperative unilateral vocal cord paralysis had return of function after removal of a substernal goiter. The other had a permanent nerve injury from the original surgery. Three patients had postoperative hypocalcemia (calcium <8.0 mg/dL). This resolved in all patients within 1 to 6 months. One patient who had a third operation for MNG had postoperative hemorrhage necessitating tracheostomy for airway control. Another patient developed a seroma that resolved within 2 months. We conclude that reoperations are indicated for both benign and malignant thyroid disease. Because they carry a higher risk of complications, every effort should be made to avoid them by performing definitive initial treatment.

Female↗
PubMed1981

Reoperation for coronary artery disease.

Forty-two reoperations for myocardial revascularization were done in 40 patients. Seventeen of them (1%) are from our series of 1,700 patients. Average number of grafts per patient was 2.27. Complications occurred in 20 patients. There was no operative or hospital (30-day) mortality. Patients classified as improved or asymptomatic constitute 82.5% of the series. Reoperations within one year were done predominantly for technical cause of failure, whereas reoperations done after more than one year were usually for disease progression. The operative technique is described as are maneuvers to help make a reoperation less hazardous. Reoperations have been accomplished relatively safely with results similar to those of initial operation.

Adult↗
PubMedDate not supplied

Gamma-probe localization of a parathyroid adenoma in the reoperative neck.

Preoperative localization of parathyroid adenomas in patients with hyperparathyroidism currently relies on a combination of computed tomography, magnetic resonance imaging, ultrasound, (99m)Tc-sestamibi scintigraphy, and venous sampling of parathyroid hormone. No procedure is universally reliable, however, and in reoperation for missed parathyroid adenomas, development of an optimal preoperative localization strategy becomes especially problematic. We report the case of a patient with hyperparathyroidism who required reoperation for a missed parathyroid adenoma despite preoperative localization with (99m)Tc-sestamibi scintigraphy. (99m)Tc-sestamibi scintigraphy was done 2.5 hours before reoperation. On reoperation, a gamma-detecting probe (C-Track; Care Wise Medical Corporation, Morgan Hill, CA) introduced through a right neck incision was used to localize a 4-cm adenoma within 45 minutes. No significant radiation hazard existed, and no special handling of the specimen was required. The patient's hyperparathyroidism resolved within 24 hours postoperatively. Therefore, this intraoperative technique may prove to be a useful adjunct to preoperative localization studies of parathyroid adenomas, particularly in patients requiring reoperation for persistent postsurgical hyperparathyroidism.

Adenoma↗
PubMed1975

Reoperation and recurrence in Crohn's colitis and ileocolitis; Crude and cumulative rates.

To determine the risks of reoperation and clinical recurrence in Crohn's disease involving the colon, we analyzed by both crude and actuarial (life-table) methods follow-up data from 160 patients hospitalized with Crohn's colitis or ileocolitis from 1964 through 1973. A total of 100 patients (63 per cent) underwent major operation; of these, 58 required reoperation. By the 15th year after initial operation, there was a cumulative reoperation rate of 89 and an overall clinical recurrence rate of 94 per cent. Crude data implied that the reoperation rate diminished with each succeeding operative procedure, from 58 per cent after the first operation to 47 per cent after the fourth. By contrast, actuarial analysis revealed that at the three-year follow-up point, the cumulative chance of reoperation increased from 37 per cent after the first surgical procedure to 60 per cent after the fourth. The inexorable tendency of Crohn's ileocolitis to require repeated operations is demonstrable by actuarial methods.

Adult↗
PubMed1976

[Indications for reoperation on brain gliomas].

The present results allow to make the following conclusions: (1) In the case of relapses or progressions of intracranial gliomata, reoperation usually yields unsatisfactory therapeutical results, often leading even to premature death of the patient. (2) Reoperations for intracranial gliomata should be decided individually. Determining their indication are the size, location, and histological character ascertained during the first intervention. Also, it is necessary to give detailed consideration to the results of both scintigraphic and angiographic examinations, which give an idea of the actual size of proliferation. (3) Relapses of malignant and relatively malignant gliomata are not reoperable. (4) Showing a relative capability of treatment by surgical reoperation are relapses of benign gliomata in functionally unimportant regions, which do not affect remote cerebral structures and which are accompanied by intracranial hypertension. (5) Reoperation is absolutely indicated in the case of relapses of spongioblastomata of the cerebellum providing the tumor does not affect the brain-stem.

Astrocytoma↗
PubMed1975

Results of reoperation for unsuccessful coronary artery bypass surgery.

Twenty-one reoperations for relief of angina have been performed at Stanford Medical Center in patients who had had previously unsuccessful direct coronary artery surgery. Complete releif of angina was obtained in seven (33%), improvement of angina in six (29%), and no change in angina in eight (38%) after these operations. Reoperation was least successful in relieving angina when performed in patients with graft occlusion and most successful when performed in patients with new critical lesions or with previously unbypassed critical lesions (P less than 0.02). Reoperation was of greater benefit in patients with unstable angina than in those with stable angina (P less than 0.05). Four of the seven patients having no angina after reoperation sustained perioperative infarctions. Reoperation does not provide the same rate of angina relief as first operations; however, certain subgroups of patients may exhibit more favorable results.

Adult↗
PubMed1981

Use of silicone rubber as a pericardial substitute to facilitate reoperation in cardiac surgery.

Reoperations following cardiac procedures have an increased risk because of the danger of damaging the heart, great vessels, or grafts because of adhesions to the sternum and anterior chest wall. We report our experience with the use of silicone rubber as a pericardial substitute in 102 patients--58 children undergoing palliative and corrective operations and 44 adults undergoing porcine valve insertion or coronary revascularization. The pericardial substitute was used only in cases in which reoperation was considered likely. There were no mediastinal infections. One adult had signs of cardiac constriction which improved markedly on administration of anti-inflammatory agents. Seven patients required reoperation for bleeding. Two patients who underwent Fontan procedures developed pericardial effusions necessitating a pericardial window. Reoperation was undertaken 1 to 12 months postoperatively in seven patients, all of whom were children. The silicon rubber greatly facilitated opening of the chest bone but did not affect the formation of adhesions within the pericardium. Postmortem examinations have been obtained in two cases 5 and 9 months postoperatively, and showed a thin layer of dense fibrous tissue adjacent to the silicone rubber. We conclude that silicone rubber may be used as a pericardial substitute and that it facilitates reoperation following cardiac operations. Particular caution should be used in patients undergoing Fontan procedures, as there appears to be a tendency for pericardial effusions and tamponade to develop.

Adult↗
PubMed1978

Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies.

During the past 3 years (June, 1974, to July, 1977), 51 patients underwent reoperation for persistent or recurrent hyperparathyroidism at the Mayo Clinica. The overall success rate for cervical reoperation was 72% and for mediastinal reoperation, was 64%. Arteriography alone provided accurate preoperative localization of missing parathyroid tumors in 11 of 17 patients at a cost per patient benefited of approximately $1,700. Selective thyroid venous sampling with parathormone assay alone correctly lateralized hyperfunctioning glands in only four of nine patients at a cost per patient benefited of approximately $1,900. When used in combination, these studies provided correct localization or lateralization of parathyroid tumors in five of seven patients at a cost per patient benefited of approximately $2,000. Three patients experienced significant neurological complications as a result of thyrocervical arteriography. There were no complications due to venous sampling. In patients who has undergone a less than thorough initial explorations due to venous sampling. In patients who had undergone a less than thorough initial exploration of the neck, the success rate for reoperation was not enhanced by obtaining preoperative tumor localization studies. However, in those patients who had had a thorough and systematic exploration of the neck at their first operations, the success rate for reoperation was almost doubled when preoperative arteriography or venous sampling (or both) was employed.

Adenoma↗