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At least 667 records · Page 37Linked to original sources
PubMed1984

[Analysis of reoperations after 10,000 lung resections].

Within a period of 17 years (1965 to 1981) 10,000 patients underwent lung resections at our dept. A reoperation was required in 392 cases. The reinterventions are classified into three groups: urgent, early and late reoperations. The proportion of urgent and early interventions is 1.2%. 392 cases are also analysed according to the type of complications, character of primary disease, as well as method of treatment. Detailed discussion is provided for the most frequent complications requiring reoperation, such as bleeding, bronchus fistula and pulmonary infarction. Viewpoints of treatment are described and method of prevention are emphasized.

Adult↗
PubMedDate not supplied

[Reoperations on the renal artery].

Twenty six reoperations on the renal artery were performed upon 19 patients. This represents a 3.6% rate of repeat surgery in the author's series of renal artery repairs. The lesions requiring surgery were 22 repeat stenoses and 4 aneurysms of saphenous vein grafts. The 26 reoperations ended with nephrectomy in 8 cases and repeat repair in 18 cases. The nephrectomies were performed because of major difficulties for a repeat repair. The repairs were performed by conventional surgery in 9 cases and ex situ surgery in 9 cases. One postoperative death occurred (5.2%). Early thrombosis of segmental branches occurred in one patient requiring secondary nephrectomy. Late thrombosis of the repair occurred in one case in spite of normal patency of the repair on early postoperative angiography, and did not require any further surgery. Three repeat stenoses occurred (15.7%): one was not reoperated, the two others underwent one nephrectomy and one repair. On the whole, 12 long term successes out of 18 repeat repairs were obtained (66.6%). The results of successful repairs on renal function and blood pressure control are similar to those of primary repairs. Two reasons explain late alterations of initially satisfactory repairs: in only 3 cases (15.7%) worsening of atherosclerosis was responsible for repeat stenoses; in the majority of cases (16 out of 19, i.e. 84.3%), late alterations of the repair or of the arterial substitute occurred. The former lesions are unavoidable, the occurrence of the latter may be prevented by adequate surgical tactics or technique of the primary operation.

Adolescent↗
PubMed1994

Coronary by-pass reoperations without cardiopulmonary by-pass: the Israeli experience.

OBJECTIVES: To evaluate results of coronary artery by-pass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB). MATERIALS AND METHODS: Thirty-two patients underwent CABG reoperation with CPB between December 1991 and December 1993. There were 29 (91%) males, and 3 (9%) females. Mean age was 62 +/- 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF < 35%. Significant associated systemic diseases included previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), and severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1-3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom were operated on through left thoracotomy. RESULTS: Only two patients (6%) had low output syndrome postoperatively; one was supported with catecholamines, and the other with intraaortic balloon pump. Hospital stay was 6.1 +/- 1.5 days (mean +/- SD). Early unfavorable outcome included operative death in one patient (3.1%), non-fatal MI in two (6%), and sternal infection in one (3%). Follow-up (10 +/- 5 months, mean +/- SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non-fatal MI, and return of angina in three (9%) patients. CONCLUSIONS: CABG reoperations without CPB should be considered, particularly for revascularization of the LAD and RCA systems. Left thoracotomy is optional for patients with disease confined to circumflex and LAD systems.

Aged↗
PubMed1995

[Bioprosthesis degeneration and reoperation in the aortic and mitral position].

In agreement with our experiences from our first study 15 patients (8 men, 7 women) underwent reoperation because of degeneration of bioprosthetic valves implanted in aortic or mitral position during the last 24 months. At reoperation 4 patients had a more complex cardiac procedure (double valve replacement, double valve replacement with bypass grafting, valve replacement with enlargement of the valvular area). There was no acute operation and only 1 patient was serious symptomatic preoperatively (NYHA IV). We revealed a mean implantation time of 126.4 months +/- 32.2 (median 130) for all bioprostheses without a significant difference in implant time regarding to aortic or mitral position. At reoperation bypass time (p = 0.001) and aortic clamp time (p = 0.011) was significantly longer compared to the first operation. There was no perioperative death, all patients are still alive and in good condition (8 of them NYHA I, 7 NYHA II). The early change of tissue degenerated bioprostheses can be carried out under elective conditions with improved postoperative outcome: mortality and morbidity remains acceptable low. In our group incremental risk factors for early mortality are severely affected patients with low functional status (NYHA IV) and acute operation. Preoperative coronary angiography remains essential for evaluation of concomitant coronary artery disease.

Adult↗
PubMed1994

Reoperation in the management of post-operative disc space infection.

Post-operative intervertebral disc space infection had been recognised as a clinical entity with its own characteristics. Various treatments have been described. During the last six years 3127 open lumbar intervertebral disc operations were performed of which 15 (0.5%) showed a post-operative discitis. We treated our patients by reoperation of the infected intervertebral disc space. The reason of reoperation consists of acquiring material for bacteriological culture and removing loose fragments. It appears to us that reoperation is facilitating early mobilisation of patients. Also attention is paid to new diagnostic possibilities.

Adult↗
PubMed1994

'No touch' dissection, antegrade-retrograde blood cardioplegia, and single aortic cross-clamp significantly reduce operative mortality of reoperative CABG.

BACKGROUND: We assessed the improvement in total and cardiac-related operative mortality in 131 consecutive patients after reoperative coronary artery bypass surgery (CABG). METHODS AND RESULTS: The patients were divided into two consecutive groups, A (1988 to 1989) and B (1990 to 1993), on the basis of the implementation of alternative techniques of myocardial protection. The techniques in group B included the "no touch" technique or minimal dissection before bypass, routine femoral artery and vein exposure, and frequent cannulation for cardiopulmonary bypass and antegrade and retrograde blood cardioplegia, with all vascular anastomoses (proximal and distal) performed with a single aortic cross-clamp and cardioplegic arrest. Cardiac mortality from low cardiac output or myocardial infarction was 15% versus 0%, P = .002. Multivariate analysis of demographics, perioperative risk factors, and myocardial protection techniques revealed that only membership in group A and the requirement for an intra-aortic balloon counterpulsation independently predicted mortality. By univariate analysis, group A had significantly more patients with three-vessel disease and patients who required urgent or emergent procedures, but analysis of patients in these subgroups also demonstrates a significant reduction in mortality in the "no touch" patients (group B). Although no technique was independently responsible for reduced operative mortality, all the myocardial protection techniques implemented in group B combined to reduce the risk of reoperative CABG. CONCLUSIONS: With appropriate myocardial protection techniques, the risk of reoperative CABG should be similar to that for a primary procedure.

Constriction↗
PubMed1994

[The causes and timing of reoperation for coronary artery disease].

In eight hundred and sixteen consecutive patients undergoing coronary artery bypass grafting (CABG) within the past 19 years (1974 to 1993), repeated CABG were performed on 12 patients (1.47%). The main reasons for repeated CABG were graft failure (GF), progression of native disease (NP) and incomplete revascularization (IR). The incidence of GF only and GF combined NP were high either within a half year or around 5 years after CABG. When the recurrence of angina is noted after CABG, the catheter intervention should be chosen at first but the reoperation should be done not so late. Although all patients survived from reoperation, three patients continued to have mild angina pectories. If a reoperation is inevitable, maximum utilization of arterial graft and accomplishment of complete revascularization are emphasized.

Aged↗
PubMed1994

[Reoperation after open mitral commissurotomy for mitral stenosis].

Between 1975 and 1993, 16 of 95 patients who received open mitral commissurotomy for mitral stenosis required reoperation for recurrent mitral lesions with a mean duration of 11 years after the initial operation at Kawasaki Medical School Hospital. The mitral lesions necessitating reoperation involved restenosis in eight, stenoinsufficiency in six and regurgitation in two. In 13 patients, mitral commissure was well separated, and the mitral restenosis and regurgitation were caused by progressions of valvular and subvalvular lesions. Significant tricuspid valve regurgitation was also seen in nine patients, and in seven out of eight patients who were in NYHA functional class III or IV, tricuspid regurgitation of grade 3 was observed. The combined tricuspid regurgitation aggravated the patient's symptoms and became a major risk factor of the reoperation after open mitral commissurotomy.

Catheterization↗
PubMed1994

The value and conduct of reoperations for coronary atherosclerosis.

The best advice for the referring physician is to find a surgical team skilled and experienced in the treatment of reoperation patients. The cardiologist and surgeon should select patients carefully, prevent complications by good technique and management, and use internal thoracic arteries whenever feasible. The reoperation must be planned and conducted precisely. Coronary artery reoperations are extensive procedures, and patients should be fully informed of the benefits and risks. Experience has resulted in fewer technical accidents today, more complete revascularization, greater use of arterial grafts, and improvements in blood conservation and myocardial protection. As a consequence, the operation is safer, and under proper conditions, stands to afford greater and longer benefit.

Coronary Artery Bypass↗
PubMed1993

Experiences with retrograde delivery of cardioplegia in coronary reoperations.

Myocardial protection is the cornerstone of cardiac surgery especially in coronary reoperation, where the most striking problem is perioperative myocardial infarction. Use of retrograde delivery of cardioplegic solution may be preferable in coronary reoperation. Experience is described with retrograde cardioplegia in 48 reoperations for myocardial revascularization, and the advantages and limitations of this technique discussed.

Adult↗
PubMed1994

Planned reoperation for trauma: a two year experience with 124 consecutive patients.

Planned reoperation is a new approach to severe truncal trauma. A review of 124 patients treated over two years was undertaken. Penetrating injuries predominated (78%) involving primarily the abdomen or abdomen and chest. An abbreviated procedure was performed when direct hemostasis was impossible (102 patients), abrupt termination was required (56 patients), or the abdomen or chest could not be closed (20 patients). The techniques employed included packing, rapid skin closure, gastrointestinal interruption, rapid vascular control, temporary urinary diversion, stapled lung resection, and plastic bag closure. Seventy-three patients survived to undergo 101 operations. The first reoperation was planned in 52 patients and unplanned (either for bleeding or for abdominal compartment syndrome) in 21 patients. There were 14 missed injuries. The overall mortality rate was 58%. Survival was significantly better when the decision to abruptly terminate the initial procedure was made early and in patients undergoing planned reoperation. Wider adoption and better definition of the indications will result in more effective use of this approach.

Abdominal Injuries↗
PubMed1994

Prophylactic reoperation for strut fractures of the Björk-Shiley convexo-concave heart valve.

Outlet strut fracture of the Björk-Shiley Convexo-Concave (C/C) heart valve is the current paradigm of structural failure of mechanical heart valve prostheses. The estimated risk of fracture for C/C valves varies from 0.02% to 2.5% per patient-year, depending on valve size, opening angle, date of manufacture and position as a mitral or aortic replacement. This report examines our experience with 396 implants, comprising 346 C/C 60 degrees valves and 50 C/C 70 degrees valves. The 30-day mortality was 1.8%. Through April 1993, mean follow up was 8.9 years, incorporating 2971 patient-years and knowledge of the current status of 91.5% (356/389) of operative survivors. Late mortality was 3.7% per patient-year, including one 60 degrees and one 70 degrees outlet strut fracture. To evaluate the risk of semi-elective valve re-replacement at our institution, we reviewed the results of isolated re-replacements of failing or incipiently failing bioprostheses in 65 patients who had no serious co-morbidity and who were NYHA Class III or lower immediately before the procedure. The 30-day mortality was 4.6% and the overall serious morbidity rate was 10.8%, necessitating six repeat reoperations. When these factors were balanced against the life expectancy and general status of five patients with large-size, higher-fracture-risk 70 degrees C/C valves, it was concluded that only two patients remained possible reoperation candidates. Consideration for re-replacement of a normally functioning C/C heart valve should take into account institution-specific experience because structural failure remains a low risk compared to valve-related complications engendered by reoperation.

Adult↗
PubMedDate not supplied

[Reoperations in appendicitis].

We present our experience in reoperations after appendectomy. From 276 patients were operated for acute appendicitis, we found 70 who presented appendicular abscess, only 13 needed reoperation because of residual abscess, (three cases), evisceration (four cases), and cecum perforation (two cases). All had history of more than four days of preoperative evolution (range 4-45 days) in those eleven patients (six men, and five women) were done 13 reoperations. We had no mortality after successful recovery in all of theme. Our experience in reported from the surgical services of Hospital General de México an Hospital Juárez, both located in México City.

Adult↗
PubMed1993

Surgical treatment of discrete and tunnel subaortic stenosis. Late survival and risk of reoperation.

BACKGROUND: Although membranectomy, with or without septal myotomy or myectomy, has been the accepted method for treatment of fixed subaortic stenosis, controversies remain regarding operative methods and uncertainties regarding recurrence of subaortic obstruction and development of aortic insufficiency after repair. METHODS AND RESULTS: To determine late survival and risk of reoperation, we reviewed 169 patients who, between 1957 and 1992, had repair of discrete (n = 108) and tunnel (n = 61) subaortic stenosis. One hundred fifty-four patients had their primary operation for subaortic stenosis at the Mayo Clinic, and 15 patients had their primary operation elsewhere. Among patients having initial repair at our institution, membranectomy was performed in 52 patients (33.8%), membranectomy plus myotomy in 24 patients (15.6%), membranectomy plus myectomy in 71 patients (46.1%), myectomy plus a Konno-Rastan procedure in 5 patients (3.2%), and myectomy plus a modified Konno-Rastan procedure in 2 patients (1.3%). For all patients, early mortality was 4.7% (2.7% since 1961), and during follow-up extending to 29 years, there have been 16 late deaths. Twenty-six patients underwent a second or third operation for recurrent left ventricular outflow obstruction, including 11 of the 154 who had their primary operation at the Mayo Clinic (7.1%). Among the 21 patients who had a discrete lesion at initial repair and required reoperation, 19 (92%) were noted to have tunnel obstruction at reoperation. At late follow-up, the left ventricular outflow tract gradient was higher in patients with tunnel versus discrete obstruction (33 +/- 5 versus 24 +/- 17 mm Hg, P < .04), and 10-year survival was poorer (79% versus 91%, P < .02). Ten-year survival was worse in patients with tunnel lesions and associated cardiac anomalies versus those with isolated tunnel subaortic stenosis (64% versus 92%, P < .005). Some degree of aortic valve insufficiency was seen at late follow-up in 26% of patients, but in most cases this was mild. For patients with discrete subaortic stenosis, risk of late aortic insufficiency was 38.6% after isolated membranectomy, 27.8% after membranectomy and myotomy, and only 7.3% after membranectomy and myectomy (P < .004). Progression of aortic insufficiency requiring aortic valve replacement occurred in only 6 patients. CONCLUSIONS: Our results support the use of myectomy in conjunction with membranectomy for discrete subaortic stenosis. For restenosis and tunnel obstruction, more complete relief of subaortic stenosis by extended resection or a modified or classical Konno-Rastan procedure may improve late survival and reduce the incidence of recurrent subaortic stenosis and late aortic valve insufficiency.

Adolescent↗
PubMed1993

Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism.

BACKGROUND: The utility of standard radiologic imaging studies in guiding reoperative parathyroid surgery for primary hyperparathyroidism is widely known and accepted. The additional information gained by selective venous sampling in that patient population has not been well defined. We report the results of our experience with this method. METHODS: Between 1982 and 1992, 223 consecutive patients underwent reoperations for persistent or recurrent primary hyperparathyroidism after a prospectively determined series of imaging studies. Patients underwent noninvasive testing consisting of ultrasonography, computed tomography, technetium thallium scanning, and magnetic resonance imaging. Patients with negative, equivocal, or discordant results on the noninvasive studies proceeded to angiography. If angiography was negative, selective venous sampling was performed. RESULTS: Eighty-six patients (39%) with negative or equivocal noninvasive test and angiogram results underwent selective venous sampling. Seventy-six patients (88%) had a significant gradient in levels of parathyroid hormone from veins draining the left side of the neck (n = 25), the right side of the neck (n = 33), both sides of the neck (n = 7), and the thymus (n = 11). Correlation of these findings with operative findings revealed a sensitivity of 88% and a specificity of 86%. In the subgroup of patients who underwent venous sampling and had completely negative results of standard radiologic studies (35 of 86; 40%), 28 patients (80%) had venous gradients and seven patients (20%) had no gradient. Of those 28 patients in whom the venous sampling gradients were the only positive localization study, the venous samplings were helpful in 23 patients (true positive gradients), and the operative success rate was 93%. In the seven patients with no positive preoperative localizing studies including venous sampling, there were two operative failures (operative success, 71%). CONCLUSIONS: Our results show that selective venous sampling is a highly sensitive and specific method to regionally localize abnormal parathyroid glands not imaged by standard noninvasive and invasive radiologic techniques. Venous sampling is the study of choice in guiding reoperative procedures for occult abnormal parathyroid glands that are undetected despite the use of all available imaging studies.

Diagnostic Imaging↗
PubMed1993

Value of technetium 99m sestamibi iodine 123 imaging in reoperative parathyroid surgery.

BACKGROUND: The purpose of this study was to assess the contribution of technetium 99m sestamibi iodine 123 (T/S) imaging to preoperative and intraoperative management of patients with persistent hyperparathyroidism. METHODS: During a period of 10 months, all patients being prepared for reoperative parathyroid surgery (n = 10), two patients deemed significant operative risks (one patient with severe chronic obstructive pulmonary disease and one patient with severe cervical spine ankylosing spondylitis), and two patients who had undergone prior thyroid operation were studied with T/S imaging. Six patients undergoing reoperative surgery had undergone one, three had undergone two, and one had undergone three prior procedures. RESULTS: T/S imaging correctly localized 14 of 16 parathyroid tumors. By comparison, only 1 of 6 thallium technetium and 3 of 12 computed tomography (CT) scans (in seven patients) were positive. T/S imaging guided the reoperative surgical approach accurately in 12 of 14 patients, including one case of an undescended left lower gland at the level of the mandible and identification of a third gland on the left in another case. Sternal split was required to remove three lesions localized by T/S imaging, two beneath the aortic arch and one nestled in the aortopulmonary window in a patient who had undergone two prior procedures including a sternal split. In these three cases T/S imaging was particularly useful, because CT scans, thallium technetium scans, magnetic resonance imaging, and arteriography were not diagnostic. The outcome after operation was favorable in all 14 cases, with correction of hypercalcemia and no permanent laryngeal nerve injuries or hypocalcemia. CONCLUSIONS: We concluded that T/S imaging is more accurate than thallium technetium and CT scans in evaluation of patients with persistent hyperparathyroidism.

Adult↗
PubMed1994

The use of unstented homograft valves for aortic valve reoperations. Review of a twenty-three-year experience.

Unstented homograft valves offer several theoretical advantages when used for patients who have had previous operations on the aortic valve. Between January 1970 and February 1993, 177 patients received unstented homograft valves after previous aortic valve operations. One hundred thirty-four patients had previous aortic valve replacement in the form of homografts (101 patients), mechanical prostheses (24 patients), and bioprostheses (9 patients), and 43 had previous valve repair. The indication for reoperation was deterioration of a noninfected valve (124 patients), infective endocarditis (40 patients), and failure of a noninfected mechanical valve (12 patients). Fresh homograft valves were implanted in 60 patients, homografts preserved in antibiotics were used in 111 patients, and 6 patients received cryopreserved valves. Aortic valve and root replacement was performed in 60 patients, and in 117 the homograft was inserted freehand in the subcoronary position. The early mortality was 5.1%. The actuarial survival at 10 years was 71%. Multivariate analysis demonstrated that patients with previous homograft replacement have a better long-term survival than patients who had previous mechanical valves (p = 0.017). The freedom from valve-related death and reoperation was 70% at 10 years. Fresh homografts faired better than antibiotic-sterilized homografts (p = 0.007). None of the patients had recurrence of endocarditis at 6 months, although 1 patient died of uncontrolled infection despite valve replacement. The freedom from recurrent endocarditis was 88% at 10 years. We conclude that unstented aortic homografts provide good early and long-term results for aortic valve reoperations, particularly in patients with previous homograft replacement. Recurrent endocarditis is uncommon even in patients operated on for prosthetic valve infections.

Adolescent↗
PubMed1994

[Reoperation with a bifurcated nonvalved extracardiac conduit for stenosis of the valved conduit and the pulmonary bifurcation after a Ross-Rastelli operation].

We report a case of successful reoperation with a bifurcated nonvalved extracardiac conduit for stenosis of the valved conduit and the pulmonary bifurcation after a Ross-Rastelli operation. The patient was 11-year-old female, who had undergone Ross-Rastelli operation with a 16 mm Carpentier-Edwards valved conduit for pulmonary atresia with ventricular septal defect at six year-old following Blalock-Taussig shunt at four year-old. She required reoperation for progressive right heart failure due to stenosis of the valved conduit and the pulmonary bifurcation. The reoperation was performed under cardiopulmonary bypass with aortic crossclamp. The stenosed valved conduit placed between the right ventricle and the right pulmonary artery was removed and replaced with 18 mm EPTFE graft. Because the direct repair of the pulmonary bifurcation stenosis was thought to be difficult, a 12 mm ringed EPTFE graft was anastomosed to the left pulmonary artery distal to the bifurcation stenosis as a branch of the 18 mm EPTFE main graft. Although transitional heart failure required IABP support in her early postoperative course, she subsequently recovered and discharged the hospital at the 37th postoperative day. Her right ventricular pressure reduced from 105 mmHg to 54 mmHg by the cardiac catheterization. She is now alive and well without any complaints.

Bioprosthesis↗