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Repeat sternotomy for aortic valve replacement safe option for octogenarian patients
Date:3/26/2014

my between January 1993 and December 2011. Of these, 111 patients (17.6%) had received a previous coronary artery bypass graft and therefore a repeat sternotomy was required. All patients had their surgery at the Mayo Clinic.

Those patients who underwent a repeat sternotomy had more pre-existing conditions and a higher predicted risk of death than those undergoing primary sternotomy. Despite the higher risk, the results in the repeat sternotomy group were similar to those in patients who received primary sternotomy. The cardiopulmonary bypass time was longer in the repeat sternotomy group compared with the primary sternotomy group, but there was no difference in the aortic crossclamp time between the two groups. Stroke occurred in three patients (2.7%) after repeat sternotomy and in 10 patients (1.9%) after primary sternotomy. Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the two groups. Seven patients (6.4%) died after repeat sternotomy and 19 patients (3.7%) died after primary sternotomy. There were no deaths in the seven patients who received either a third or fourth sternotomy.

"The main finding in our study is that repeat sternotomy is not a predictor of operative mortality for isolated surgical aortic valve replacement," says Dr. Greason. "Repeat sternotomy and surgical aortic valve replacement can be done with low risk in patients in their 80s." He observes however that "These patients were operated on at a high-volume center and were selected for operation by a group of surgeons well versed in complex reoperative cardiac surgical procedures, so these results may not be reproducible at centers without the same degree of experience. An option may be to refer these patients to a specialist center."


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Contact: Nicole Baritot
press@aats.org
978-299-4520
American Association for Thoracic Surgery
Source:Eurekalert

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