Retrospective Study Of Redo Cardiac Surgery In A Single Centre

Karthekeyan, Ranjith B.; Selvaraju M.D., Karthikeyan N.; Ramanathan, Lakshmi; Rakesh, M. G.; Rao, K. G. Suresh; Vakamudi, Mahesh; Balakrishnan, K. R.
July 2007
Internet Journal of Anesthesiology;2007, Vol. 13 Issue 1, p29
Academic Journal
Background: An increasing number of patients are being referred to tertiary referral centre for re-do cardiac surgery and will continue to increase. Though it is a sign of improving medical care and better management, it is a challenge for every cardiac anesthesiologist in handling this subset of patients. This subset of patients pose specific set of problems both for the surgeon and the anesthesiologist such as in gaining sufficient exposure to enable repair, limiting blood loss, associated pulmonary hypertension, valvular dysfunction and requires special attention at all stages of management. Also this subset of patients is frequently compromised and has little reserve to compensate for the surgical related stress and other evolving problems. Aim: To study the in hospital outcome of patients undergoing re-do cardiac surgery in a single tertiary referral centre. Methods: Data was collected from 42 patients who underwent re-do cardiac surgery between January 1, 2005 to December 31, 2006. All patients who had sternotomy at least three months before were included in the study. Both congenital and adult re-do's were included in this retrospective study. The following factors were collected in the retrospective study: duration since previous surgery, intraoperative complications, postoperative complications, duration of ventilation, amount of blood transfused, aprotinin usage, route of establishment in cardiopulmonary bypass (femorofemoral or right atrial aortic), elective or emergency cardiopulmonary bypass, surgical approach- sternotomy or thoracotomy, intra aortic balloon pump insertion, tracheostomy and total circulatory arrest. Result: Unexpected injuries to the heart or great vessels occurred in 4 patients during repeat median sternotomy (9.5%). The mean duration of surgery was 210 minutes (90-340 minutes), mean cardiopulmonary bypass time was 83 minutes (20-160 minutes), mean cross clamp time was 49.6 minutes (15-100 minutes). The duration of total circulatory arrest ranged from 20-30 minutes (mean duration 22 minutes) The mean duration of ventilation was about 35 hours (6hrs to 168hrs). Re-exploration was required in 2 patients. Mean chest tube drainage was about 434 ml (60 — 1000 ml). Two patients developed stroke (4.7%). Mean duration of ICU stay was 7 days (3 days to 42 days). Tracheostomy was done in two patients (4.7%). The mortality rate was 7.1% (3 out of 42 patients). Conclusion: Modifications in all aspects of the re-do cardiac surgery will continue to evolve as surgeons and anesthesiologists are confronted by an ever-increasing number of patients requiring re-operation. Recently a definite trend has been observed toward reduction of operative risk. Improvements in postoperative intensive care probably contributed to this tendency. Special attention to cannulation techniques, perfusion conditions, valve exposure and de-airing maneuvers are all important to ensure good clinical results.


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