Effect of Repeat Sternotomy on Cardiac Surgery Outcomes

Purpose: To determine the impact of repeat sternotomy after adult cardiac surgery on surgical outcomes. The primary endpoints include operative mortality and rate of reoperation for bleeding. Methods: A retrospective review of prospectively collected data from a single institution. The patients underwent coronary artery bypass grafting (CABG), valvular surgery, CABG and valvular surgery and other procedures from July 1st, 2011 to December 31st, 2013. Charts were evaluated for demographics, operative details and postoperative outcomes. Operative mortality was defined as death within 30-days of surgery. Results: We identified 165 patients who underwent 170 total adult cardiac surgery procedures. The average age of the patients was 68.93 ± 13.3 and the majority of the patients were male (N=116). The patient's original surgical procedures were predominantly CABG (39%), with the remaining patients having undergone valvular surgery (26%), and other procedures (35%) including insertion of a left ventricular assist device (Figure 1). Of the redo-sternotomy procedures the majority of patients underwent valvular surgery (52%) either multiple valve procedures or combination of CABG and valvular surgery. The remaining patients had other procedures (37%) performed including orthotropic heart transplantation, and the rest underwent CABG (11%) (Figure 2). The mortality rate was 7% for the entire group with 4% mortality for aortic valve replacement (AVR), 3% for mitral valve procedures and 0% for CABG. The rate of reoperation for bleeding was 2.4% for the entire group with 1.9% for AVR, and 0% for CABG. Conclusions: Repeat sternotomy has increased risk for patients undergoing adult cardiac surgery. The data from our study shows that the patients who underwent redo-sternotomy had low mortality and the rate of reoperation is low at 2.4% for postoperative bleeding. Although the risks are enhanced with the proper preparation patients can have successful outcomes.