Repeat Sternotomy: No Longer a Risk Factor in Mitral Valve Surgical Procedures

Background. The incidence of reoperative mitral valve (MV) surgical procedures is increasing, representing more than 10% of all MV operations in the United States. Previous clinical series have reported mortality rates of 5% to 18% and reentry injury rates of 5% to 10% for reoperative MV operations. Methods. Between January 2004 and June 2012, 1,312 MV operations were performed on 1,275 patients. We excluded 234 patients who underwent small incision primary right thoracotomy, 11 redo operations with first or second operation other than sternotomy, and 10 emergent operations, leaving 1,056 MV operations for analysis (first-time sternotomy, 926 [88%]; repeat sternotomy, 130 (12%]). Preoperative computed tomography was performed for all repeat sternotomy patients. Patients at risk for reentry injury were identified, and protective strategies were applied systemically before resternotomy procedures. Results. Among 130 patients undergoing reoperative MV operations, 35% (46/130) had prior coronary artery bypass grafting (CABG), 15% (19/130) aortic valve operations, and 61% (80/130) MV operations. Sixteen percent (21/130) had more than one previous sternotomy. Operative mortality was 4.6% (43/926) for first-time procedures and 4.6% (6/130) for reoperative MV operations. Intraoperative injury (innominate vein) occurred during repeat sternotomy in 2 (1.5%) patients. Stroke occurred in 3 patients (2%) who underwent repeat sternotomy and in 22 (2%) who underwent first-time sternotomy. On multivariable analysis, preoperative New York Heart Association function class, concomitant CABG, dialysis, and higher pulmonary artery pressures were associated with operative mortality, and repeat sternotomy was not. Conclusions. With careful planning and execution, outcomes for reoperative MV operations in contemporary practice are favorable and are identical with those for first-time operations. (c) 2013 by The Society of Thoracic Surgeons