Study of Re-operation on Patients with Congenital Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUXiao-song ,  YANGKe-ming , LVXiao-dong , WEIYi-zhen , ZHAOYu-chen , SUNZhi-qiang

Department of Pediatric Cardiovascular Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

YANGKe-ming, Email: 13801217526@163.com

Keywords：

Adult; Congenital heart disease; Re-operation

DOI：

10.7507/1007-4848.20160164

Video：

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Objective To summarize the clinical outcome and strategy of re-operation on adult and older children patients with congenital heart disease. Methods We retrospectively analyzed the clinical data of 339 patients underwent re-operation in our hospital from January 2010 to December 2014. There were 214 males and 125 females at the mean age of 21.6±12.4 years. According to the pathophysiological result and the difficulty level of operation, patients were divided into a simple re-operation group (n=186) and a complex re-operation group (n=153) . We compared the clinical outcomes of two groups. Results In the simple re-operation group, the rate of mortality was zero and the rate of complications was 5.9%. There was 1 patient of interoperative right atrium injury, 1 patient of extensive hemorrhage, 5 patients of postoperative secondary thoracotomy, 1 patient of hemodialysis, 3 patients of severe infection, and 2 patients of Ⅲ degree atrioventricular blockage. In the complex re-operation group, the rate of mortality was 3.3% and the rate of complication was 30.1%. There were 2 patients of intraoperative coronary artery lesion, 2 patients of aortic injury, 1 patient of pulmonary artery injury, 6 patients of extensive bleeding, 8 patients of postoperative secondary thoracotomy, 13 patients of hemodialysis, 12 patients of severe infection, 5 patients of nervous system complications, 4 patients of Ⅲ degree atrioventricular blockage. Extracorporeal membrane oxygenation (ECMO) applied in 4 patients. Conciusion Complex re-operation is still the influential factor of mortality and complications for patients with congenital heart disease and we should take measures to aviod the mortality and complications.

Citation： HUXiao-song, YANGKe-ming, LVXiao-dong, WEIYi-zhen, ZHAOYu-chen, SUNZhi-qiang. Study of Re-operation on Patients with Congenital Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 684-687. doi: 10.7507/1007-4848.20160164 Copy

1.	Warnes CA. The adult with congenital heart disease:born to be bad? J Am Coll Cardiol, 2005, 46(1) :1-8.
2.	蒋振斌, 周光华, 王哲, 等. 先天性心脏病再次手术体会. 上海医学, 1998, 21(4) :191-192.
3.	张怀军, 许建屏, 孙立忠, 等. 法洛四联症术后三尖瓣关闭不全的外科治疗. 中国医刊, 2004, 39(7) :39-40.
4.	张怀军, 孙立忠, 郭立新, 等. 法洛四联症根治术后肺动脉瓣置换术. 中国胸心血管外科临床杂志, 2005, 12(1) :50-51.
5.	范祥明, 闫军, 刘迎龙, 等. 先天性二尖瓣关闭不全的再次手术. 心肺血管壁杂志, 2008, 29(3) :200-202.
6.	朱平, 杨红伟, 陈恒, 等. 部分型房室隔缺损患者再次手术三例. 中国胸心血管外科临床杂志, 2009, 16(5) :417-417.
7.	李轩,姜睿,闫鹏,等. 法洛四联症根治术后再次手术56例原因分析. 心肺血管壁杂志, 2014, 33(2) :172-177.
8.	Jacobs JP, Mavroudis C, Quintessenza JA, et al. Reoperations for pediatric and congenital heart disease:An analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2014, 17(1) :2-8.
9.	Russell JL, LeBlanc JG, Sett SS, et al. Risks of repeat sternotomy in pediatric cardiac operations. Ann Thorac Surg, 1998, 66(5) :1575-1578.
10.	Elahi MM, Kirke R, Lee D, et al.The complications of repeat median sternotomy in paediatrics:six-months follow-up of consecutive cases. Interact Cardiovasc Thorac Surg, 2005, 4(4) :356-359.
11.	DeLeon SY, LoCicero J, Ilbawi MN, et al. Repeat median sternotomy in pediatrics:experience in 164 consecutive cases. Ann Thorac Surg, 1986, 41(2) :184-188.
12.	Morales DL, Zafar F, Arrington KA, et al. Repeat sternotomy in congenital heart surgery:no longer a risk factor. Ann Thorac Surg, 2008, 86(3) :897-902.
13.	Park CB, Suri RM, Burkhart HM, et al. Identifying patients at parti-cular risk of injury during repeat sternotomy:analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5) :1028-1035.
14.	Sabik JF, Blackstone EH, Houghtaling PL, et al. Is reoperation still a risk factor in coronary artery bypass surgery? Ann Thorac Surg, 2005, 80(3) :1719-1727.
15.	王崇, 韩林, 陆方林, 等. 再次心脏瓣膜手术325例临床分析. 中国胸心血管外科临床杂志, 2013, 20(1) :24-28.
16.	Potter DD, Sundt TM, Zehr KJ, et al. Operative risk of reoperative aortic valve replacement. J Thorac Cardiovasc Surg, 2005, 129:94-103.
17.	Potter DD, Sundt TM, Zehr KJ, et al. Risk of repeat mitral valve replacement for failed mitral valve prostheses. Ann Thorac Surg, 2004, 78(1) :67-72.
18.	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.
19.	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) :122-130.
20.	Bhat AH, Sahn DJ. Congenital heart disease never goes away, even when it has been ‘treated’:the adult with congenital heart disease. Curr Opin Pediatr, 2004, 16(5) :500-507.
21.	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.
22.	Morishita K, Kawaharada N, Fukada J, et al. Three or more median sternotomies for patients with valve disease:Role of computed tomography. Ann Thorac Surg, 2003, 75(5) :1476-1481.

1. Warnes CA. The adult with congenital heart disease:born to be bad? J Am Coll Cardiol, 2005, 46(1) :1-8.
2. 蒋振斌, 周光华, 王哲, 等. 先天性心脏病再次手术体会. 上海医学, 1998, 21(4) :191-192.
3. 张怀军, 许建屏, 孙立忠, 等. 法洛四联症术后三尖瓣关闭不全的外科治疗. 中国医刊, 2004, 39(7) :39-40.
4. 张怀军, 孙立忠, 郭立新, 等. 法洛四联症根治术后肺动脉瓣置换术. 中国胸心血管外科临床杂志, 2005, 12(1) :50-51.
5. 范祥明, 闫军, 刘迎龙, 等. 先天性二尖瓣关闭不全的再次手术. 心肺血管壁杂志, 2008, 29(3) :200-202.
6. 朱平, 杨红伟, 陈恒, 等. 部分型房室隔缺损患者再次手术三例. 中国胸心血管外科临床杂志, 2009, 16(5) :417-417.
7. 李轩,姜睿,闫鹏,等. 法洛四联症根治术后再次手术56例原因分析. 心肺血管壁杂志, 2014, 33(2) :172-177.
8. Jacobs JP, Mavroudis C, Quintessenza JA, et al. Reoperations for pediatric and congenital heart disease:An analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2014, 17(1) :2-8.
9. Russell JL, LeBlanc JG, Sett SS, et al. Risks of repeat sternotomy in pediatric cardiac operations. Ann Thorac Surg, 1998, 66(5) :1575-1578.
10. Elahi MM, Kirke R, Lee D, et al.The complications of repeat median sternotomy in paediatrics:six-months follow-up of consecutive cases. Interact Cardiovasc Thorac Surg, 2005, 4(4) :356-359.
11. DeLeon SY, LoCicero J, Ilbawi MN, et al. Repeat median sternotomy in pediatrics:experience in 164 consecutive cases. Ann Thorac Surg, 1986, 41(2) :184-188.
12. Morales DL, Zafar F, Arrington KA, et al. Repeat sternotomy in congenital heart surgery:no longer a risk factor. Ann Thorac Surg, 2008, 86(3) :897-902.
13. Park CB, Suri RM, Burkhart HM, et al. Identifying patients at parti-cular risk of injury during repeat sternotomy:analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5) :1028-1035.
14. Sabik JF, Blackstone EH, Houghtaling PL, et al. Is reoperation still a risk factor in coronary artery bypass surgery? Ann Thorac Surg, 2005, 80(3) :1719-1727.
15. 王崇, 韩林, 陆方林, 等. 再次心脏瓣膜手术325例临床分析. 中国胸心血管外科临床杂志, 2013, 20(1) :24-28.
16. Potter DD, Sundt TM, Zehr KJ, et al. Operative risk of reoperative aortic valve replacement. J Thorac Cardiovasc Surg, 2005, 129:94-103.
17. Potter DD, Sundt TM, Zehr KJ, et al. Risk of repeat mitral valve replacement for failed mitral valve prostheses. Ann Thorac Surg, 2004, 78(1) :67-72.
18. 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.
19. 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) :122-130.
20. Bhat AH, Sahn DJ. Congenital heart disease never goes away, even when it has been ‘treated’:the adult with congenital heart disease. Curr Opin Pediatr, 2004, 16(5) :500-507.
21. 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.
22. Morishita K, Kawaharada N, Fukada J, et al. Three or more median sternotomies for patients with valve disease:Role of computed tomography. Ann Thorac Surg, 2003, 75(5) :1476-1481.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Study of Re-operation on Patients with Congenital Heart Disease

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