Repeated sternotomy after mitral valve repair: no longer a risk factor_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHONG Zhaoji , YUE Ziqi , ZHAO Zhenhua , XU Jianping , LU Feng , WANG Shuiyun , WANG Xin ,  LIU Sheng

Department of Cardiovascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Science, Beijing, 100037, P.R. China;

Corresponding author：

LIU Sheng, Email: fuwailiusheng@sina.com

Keywords：

Mitral valve repair; repeated sternotomy; safety

DOI：

10.7507/1007-4848.201601049

Video：

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Objective To explore the safety and complications of repeated sternotomy after mitral valve repair and prevention strategies. Methods We retrospectively analyzed the clinical data of 88 consecutive patients of non-rheumatic mitral valve disease who underwent repeated sternotomy for failure of first-time mitral valve repair in our hospital from January 2009 through June 2015. There were 53 males and 35 females with a mean age of 36.1±17.5 years in the patients who underwent repeated sternotomy. Meanwhile 88 patients who underwent the first-time sternotomy for mitral valve repair simultaneously were randomly recruited as a control group, and there were 57 males and 31 females with a mean age of 39.9±12.6 years. The clinical outcomes were analyzed retrospectively and compared between the two groups. Results No major injury was observed in the patients who underwent repeated sternotomy. Eight patients (9.1%) in the repeated sternotomy group required femoral artery cannulation. Cardiopulmonary bypass (CPB) time was longer in the femoral artery cannulation group than that in the aortic cannulation group (155.5±59.0 minvs. 119.5±39.9 min,P=0.023). While there was no statistical difference in aortic cross-clamp time (P=0.786). Eight patients (9.1%) in the repeated sternotomy group used extra-pericardium approach. There was no significant difference in CPB time (P=0.255) or aortic cross-clamp time (P=0.360) between the patients who used extra-pericardium approach and those used routine approach. There was no statistical difference in post-operative complications between the patients who used different sternotomy strategies. Although CPB time (123.0±3.0 minvs. 95.4±37.1 min,P=0.000) or aortic cross-clamp time (79.0±36.3 minvs. 67.5±29.1 min,P=0.026) was longer in the repeated sternotmy group, the major outcomes were similar between the repeated sternotmy group and the first-time sternotmy group (P＞0.05). Conclusion Repeated sternotomy after mitral valve repair is relatively safe. With appropriate strategies, repeated sternotomy is not associated with increased risk of operative morbidity.

Citation： ZHONGZhaoji, YUEZiqi, ZHAOZhenhua, XUJianping, LVFeng, WANGShuiyun, WANGXin, LIUSheng. Repeated sternotomy after mitral valve repair: no longer a risk factor. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 30-35. doi: 10.7507/1007-4848.201601049 Copy

1.	Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg, 2007, 31(2): 267–275.
2.	Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962–970.
3.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): e1–e132.
4.	Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230–237.
5.	Mcneely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157–162.
6.	Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819–826.
7.	Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885–893.
8.	Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: a 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828–1837.
9.	Elahi M, Dhannapuneni R, Firmin R, et al. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc Thorac Ann, 2005, 13(2): 135–138.
10.	Luciani N, Anselmi A, De Geest R, et al. Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results. J Thorac Cardiovasc Surg, 2008, 136(3): 572–577.
11.	Ellman PI, Smith RL, Girotti ME, et al. Cardiac injury during resternotomy does not affect perioperative mortality. J Am Coll Surg, 2008, 206(5): 993–999.
12.	Roselli EE, Pettersson GB, Blackstone EH, et al. Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovasc Surg, 2008, 135(2): 316–323, 321–323.
13.	Park CB, Suri RM, Burkhart HM, et al. Identifying patients at particular risk of injury during repeat sternotomy: analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5): 1028–1035.
14.	Holst KA, Dearani JA, Burkhart HM, et al. Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg, 2011, 92(1): 122–128, 129–130.
15.	Ghoreishi M, Dawood M, Hobbs G, et al. Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures. Ann Thorac Surg, 2013, 96(4): 1358–1365.
16.	Imran HU, Digney R, Soo L, et al. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg, 2015, 47(5): 819–823.
17.	姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口二尖瓣手术同期修复三尖瓣病变的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(7): 646–649.
18.	刘洪端, 李新, 于风旭, 等. 右胸前外侧微创小切口二尖瓣成形术的疗效分析. 中国胸心血管外科临床杂志, 2014, 21(2): 194–197.
19.	Kim DC, Chee HK, Song MG, et al. Comparative analysis of thoracotomy and sternotomy approaches in cardiac reoperation. Korean J Thorac Cardiovasc Surg, 2012, 45(4): 225–229.
20.	Chung JW, Chee HK, Kim JS. Two approaches for repeat cardiac surgery. J Cardiothorac Surg, 2012, 7: 114.
21.	Mihos CG, Santana O, Lamas GA, et al. Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy. Ann Thorac Surg, 2011, 91(6): 1824–1827.
22.	Umakanthan R, Petracek M R, Leacche M, et al. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. J Heart Valve Dis, 2010, 19(2): 236–243.
23.	Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709–714.

1. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg, 2007, 31(2): 267–275.
2. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962–970.
3. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): e1–e132.
4. Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230–237.
5. Mcneely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157–162.
6. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819–826.
7. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885–893.
8. Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: a 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828–1837.
9. Elahi M, Dhannapuneni R, Firmin R, et al. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc Thorac Ann, 2005, 13(2): 135–138.
10. Luciani N, Anselmi A, De Geest R, et al. Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results. J Thorac Cardiovasc Surg, 2008, 136(3): 572–577.
11. Ellman PI, Smith RL, Girotti ME, et al. Cardiac injury during resternotomy does not affect perioperative mortality. J Am Coll Surg, 2008, 206(5): 993–999.
12. Roselli EE, Pettersson GB, Blackstone EH, et al. Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovasc Surg, 2008, 135(2): 316–323, 321–323.
13. Park CB, Suri RM, Burkhart HM, et al. Identifying patients at particular risk of injury during repeat sternotomy: analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5): 1028–1035.
14. Holst KA, Dearani JA, Burkhart HM, et al. Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg, 2011, 92(1): 122–128, 129–130.
15. Ghoreishi M, Dawood M, Hobbs G, et al. Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures. Ann Thorac Surg, 2013, 96(4): 1358–1365.
16. Imran HU, Digney R, Soo L, et al. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg, 2015, 47(5): 819–823.
17. 姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口二尖瓣手术同期修复三尖瓣病变的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(7): 646–649.
18. 刘洪端, 李新, 于风旭, 等. 右胸前外侧微创小切口二尖瓣成形术的疗效分析. 中国胸心血管外科临床杂志, 2014, 21(2): 194–197.
19. Kim DC, Chee HK, Song MG, et al. Comparative analysis of thoracotomy and sternotomy approaches in cardiac reoperation. Korean J Thorac Cardiovasc Surg, 2012, 45(4): 225–229.
20. Chung JW, Chee HK, Kim JS. Two approaches for repeat cardiac surgery. J Cardiothorac Surg, 2012, 7: 114.
21. Mihos CG, Santana O, Lamas GA, et al. Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy. Ann Thorac Surg, 2011, 91(6): 1824–1827.
22. Umakanthan R, Petracek M R, Leacche M, et al. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. J Heart Valve Dis, 2010, 19(2): 236–243.
23. Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709–714.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Repeated sternotomy after mitral valve repair: no longer a risk factor

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