Outcomes of complicated congenital heart diseases following multiple re-sternotomy operations: A single-center experience_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Yongxuan , DU Xinwei , WANG Shunmin , ZHENG Jinghao , ZHANG Haibo ,  ZHANG Hao

Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, National Children’s Medical Center, Shanghai Institution of Pediatric Congenital Heart Disease, Medical School of Shanghai Jiao Tong University, Shanghai, 200127, P.R.China;

Corresponding author：

ZHANG Hao, Email: drzhanghao@yahoo.com

Keywords：

Congenital heart disease; re-operation; functional single ventricle; pulmonary atresia; double outflow tract of right ventricle; treatment

DOI：

10.7507/1007-4848.202004022

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Objective To analyze the outcomes of complicated congenital heart diseases (CCHD) patients accepting multiple (>2) re-sternotomy operations.Methods We retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center. There were 95 males and 51 females with an age of 4.3 (3.1-6.8) years and a weight of 15.3 (13.4-19.0) kg at last operation.Results The top three cardiac malformations were pulmonary atresia (n=51, 34.9%), double outflow of right ventricle (n=36, 24.7%) and functional single ventricle (n=36, 24.7%). A total of 457 sternotomy procedures were performed, with 129 (88.3%) patients undergoing three times of operations and 17 (11.7%) patients undergoing more than three times. Fifty-two (35.6%) patients received bi-ventricular repair, 63 (43.1%) patients received Fontan-type procedures, and 31 (21.2%) patients underwent palliative procedures. Ten (6.8%) patients experienced major accidents during sternotomy, including 7 (4.8%) patients of urgent femoral artery and venous bypass. Eleven (7.5%) patients died with 10 (6.8%) deaths before discharge. The follow-up time was 20.0 (5.8-40.1) months, and 1 patient died during the follow-up. The number of operations was an independent risk factor for the death after operation.Conclusion Series operations of Fontan in functional single ventricle, repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation. Multiple operations are a huge challenge for CCHD treatment, which should be avoided.

Citation： PENG Yongxuan, DU Xinwei, WANG Shunmin, ZHENG Jinghao, ZHANG Haibo, ZHANG Hao. Outcomes of complicated congenital heart diseases following multiple re-sternotomy operations: A single-center experience. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 635-639. doi: 10.7507/1007-4848.202004022 Copy

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1. 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.
2. Yin C, Yan J, Li S, et al. Effect analysis of repeat sternotomy in pediatric cardiac operations. J Cardiothorac Surg, 2015, 10: 179-183.
3. Imran Hamid U, 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.
4. Said SM, Dearani JA. Strategies for high-risk reoperations in congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2014, 17(1): 9-21.
5. 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.
6. Kirshbom PMM, Myung RJM, Simsic JMM, et al. One thousand repeat sternotomies for congenital cardiac surgery: risk factors for reentry injury. Ann Thorac Surg, 2009, 88(1): 158-161.
7. 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 Annu, 2014, 17(1): 2-8.
8. 唐轶伦, 卢婷, 袁浩泳, 等. 147例先天性心脏病再次手术的回顾性分析. 中南大学学报 (医学版), 2019, 9(44): 1035-1040.
9. Swartz MF, Schiralli MP, Angona R, et al. The effect of repeat sternotomy during right ventricular outflow tract reconstruction. Congenit Heart Dis, 2013, 8(2): 142-148.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes of complicated congenital heart diseases following multiple re-sternotomy operations: A single-center experience

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