Methods
This is a single centre, retrospective study. Data for re-sternotomy for
AVR with or without another concomitant cardiac procedure were
retrospectively collected from 2000 – 2019 from the hospital database
(Patient Administration System, e-CAMIS, Yeadon, Leeds, UK). All
patients with previous CABG who had re-sternotomy for AVR with or
without another concomitant cardiac procedure were included.
Emergency/salvage operations and infective endocarditis were excluded.
Approval was obtained from the institutional review committee. Consent
for individual use of data was waived due to the nature of the study and
prior approval for use of such data at the time of consent for
procedures.
Baseline demographic characteristics included variables used for risk
stratification as previously defined for EuroSCORE (table 1). Data for
previous operations was collected for number of previous sternotomies,
type of previous surgery, left internal mammary artery (LIMA) use and
patency and presence of other grafts. Operative and postoperative data
included type and extent of surgery, injury to cardiac structures at
re-sternotomy, myocardial protection, cross clamp time, total bypass
time, re-exploration for bleeding/tamponade, new postoperative transient
ischemic attack (TIA)/stroke, new hemofiltration, deep sternal wound
infection, in-hospital mortality (death before hospital discharge) and
length of stay (number of days from the date of operation to discharge).
The standard procedure of re-sternotomy at our institution was followed.
The strategy of peripheral cannulation prior to re-sternotomy was based
on surgeon preference and perceived risk of injury at re-entry. All
re-sternotomies were performed with an oscillating saw. All cardiac
injuries and catastrophic bleeding at re-entry were dealt with standard
protocols. For patent LIMA, a strategy of endovascular balloon occlusion
or isolation and clamping after re-sternotomy was employed. Myocardial
protection was achieved with cold blood antegrade or retrograde
cardioplegia with use of mild to moderate systemic hypothermia.