Cardiac Reoperation Timing Shows No Effect on Mortality

TOPLINE:

Compared with later cardiac reoperations, early reoperations demonstrate increased technical complexity with longer operative times and higher requirements for blood transfusion yet show no significant difference in rates of mortality.

METHODOLOGY:

• Researchers conducted this study to explore how the interval between previous cardiac surgeries and subsequent reoperations affects operative mortality and the complexity of the procedures involved.
• They included 6021 cardiac reoperations involving resternotomy performed at the Cleveland Clinic from 2008 to 2017; preoperative CT scans were required for all patients to be included in the study.
• The reoperations included 597 coronary artery bypass graftings (CABGs), 2557 isolated valve surgeries, 1743 thoracic aorta surgeries, 954 combined valve and CABGs, and 170 other surgeries.
• Operative mortality was assessed for four time intervals from the previous surgery: 15 years.
• Surgical difficulty was assessed through the length of the procedures and the amount of blood transfusions needed.

TAKEAWAY:

• Operative mortality across the cohort was 3.3%, with no significant difference between early reoperations (3.6%) compared with intervals of 1-5 years (3.1%), 5-15 years (3.4%), and > 15 years (3.2%) (P = .96).
• An increase in mortality was observed among isolated redo CABG cases within the first year (P = .04); however, the small number of deaths in this group prevented definitive conclusions about the association, according to the researchers.
• Early reoperations were associated with increased surgical complexity, with prolonged operative times (median, 402 minutes), greater requirement for intraoperative blood transfusions (77%), and a high anatomical risk (12%).
• Nonelective surgery, lower hematocrit levels, higher creatinine levels, a higher New York Heart Association functional class, and a lower left ventricular ejection fraction were the most common factors associated with operative mortality.

IN PRACTICE:

The findings “underscore the need for thorough preoperative planning and risk assessment, particularly for early redo of patients who underwent CABG,” the authors of the study wrote. “By understanding these complexities, experienced surgeons tailor management strategies, improving outcomes and neutralizing the high risk.”

SOURCE:

This study was led by Richard Ramsingh, MD, of the Department of Thoracic and Cardiovascular Surgery at the Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, in Cleveland, and was published online on December 18, 2024, in JAMA Surgery.

LIMITATIONS:

No limitations were reported for the study.

DISCLOSURES:

No funding information was provided for the study. Some authors reported receiving personal, consulting, speaking, or license fees from various pharmaceutical companies outside the submitted work and other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.