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At least 253 records · Page 14Linked to original sources

PubMed1994

Reoperative cardiac valve surgery: a multivariable analysis of risk factors.

From December 1983 to March 1992, of 1650 patients who underwent a cardiac valve procedure 41 (2.5%) underwent reoperation on prosthetic heart valves. The indications for reoperation were: structural degeneration (13 patients, 32%), non-structural dysfunction (nine patients, 22%), prosthetic valve endocarditis (seven patients, 17%), valve thrombosis (four patients, 10%), native valve pathology (three patients, 7%), aortic ascending pathology (five patients, 12%). The hospital mortality rate for mitral valve reoperation was 12% (two of 17) and for reoperation on the aortic prosthesis 26% (five of 19). No deaths occurred for associated mitral and aortic replacement (zero of five). The mortality rate for associated procedures was 24% (four of 17) versus 12% (three of 24) for isolated procedures. Preoperative and operative variables were analysed to determine risk factors for hospital mortality. New York Heart Association functional class, ascites, endocarditis and surgical timing had a univariate influence on operative mortality. The pulmonary capillary wedge pressure and preoperative creatinine level were also higher in non-survivors. Elective reoperation had a mortality rate of 7%, while that for emergency procedures was 38%. Multivariable analysis indicated a longer extracorporeal circulation time and the urgent-emergency status as predictors of mortality. Reoperation before severe haemodynamic impairment occurs is recommended.

Aortic Valve↗

PubMed1994

Early and late outcome after reoperation for prosthetic valve dysfunction: analysis of 549 patients during a 26-year period.

Factors influencing operative mortality and late survival of 549 patients undergoing a first reoperation for prosthetic valve failure during the interval from 1966 to 1992 were analyzed; 347 patients had reoperation on a mitral prosthesis, 173 on an aortic prosthesis and 29 on both aortic and mitral prostheses. Univariate analysis showed that hospital mortality was higher in patients in functional class IV compared with those in class II-III (35% vs. 8%, p < 0.001), in those who required emergency reoperation (57% vs. 11%, p < 0.001), in those reoperated for endocarditis (59%) or valve thrombosis (43%) compared with those reoperated for structural valve deterioration (9%, p < 0.001), and in those with a failing mechanical prosthesis compared to patients with a bioprosthesis (21% vs. 10%, p < 0.05). Furthermore, operative mortality decreased from 41% in the period from 1966 to 1977, to 12% from 1977 to 1983 and to 8% from 1984 to 1992 (p < 0.001). Hospital survivors were followed from 0.1 to 22 years (mean follow-up 11 +/- 5 years) with an overall actuarial survival at 15 years of 24 +/- 5%. At 15 years actuarial survival is 24 +/- 5% for patients in preoperative functional class II-III and 20 +/- 6% for those in functional class IV (p < 0.05). It is concluded that in prosthetic valve recipients both early and late outcome is greatly influenced by preoperative clinical status. Increasing surgical experience, better myocardial protection and patient management have contributed to reducing the operative risk. More accurate patient follow up and possibly earlier reoperation might also improve the long term outcome.

Adolescent↗

PubMed1993

Clinical study of 47 patients with reoperation after open mitral commissurotomy.

Mitral lesion in 47 patients who received reoperation after an initial open mitral commissurotomy (OMC) for mitral stenosis (MS) was studied. The diagnosis before OMC consisted of pure MS in 38 patients, with mild mitral regurgitation (MR) in 8 and with moderate MR in 1. At OMC the diameter of the mitral orifice was a mean of 1.3 +/- 0.5 cm and a mobile cusp was found in 12 and a thickened cusp in 35 patients. Subvalvular fusion was seen in 15 patients, calcification of cusp or subvalvular region in 10 and left atrial thrombus in 6. After OMC, the diameter of the mitral orifice was opened to a mean of 3.2 +/- 0.3 cm. The interval between the initial operation and the time of reoperation was a mean of 124 months. The mitral lesion necessitating reoperation was MS in 18, moderate to severe MR in 10, and MSR in 19. At reoperation the mitral orifice ranged in diameter from 0.8 to 4.2 cm (mean, 2.3 +/- 0.8 cm). There was no correlation between the occurrence of MR or restenosis and the subvalvular division at initial OMC. Left atrial thrombus was identified in four and calcification in 17 patients. At reoperation 46 patients received mitral valve replacement, while only 1 received a second OMC. The removed valve showed no pathological findings of active rheumatic lesion but more severe calcification and hyalinization of the valve than those at initial operation. There were three early deaths (6.4%) after reoperation. The recurring mitral lesion seemed to consist of deteriorated pathological changes of the valve and MR and thus mitral valve replacement was recommended to provide a favorable operative result for non-flexible lesion after OMC.

Adult↗

PubMed1993

[Reoperations in parathyroid surgery].

In a continuous series of 439 parathyroidectomies for primary or secondary hyperparathyroidism, 36 cases were reoperations. The initial operation had been a prior parathyroid exploration (PTx) in 17 cases, a thyroidectomy (Tx) in 17 cases, both operations in two cases. The incidence of parathyroid glands discovered at exploration was lower in both types of reoperations (67% after Tx, 72% after PTx) than in patients who were explored for the first time (94%). Anatomical variations and parathyroid pathologies were comparable in patients reoperated after Tx and in those explored for the first time. In patients reoperated after PTx, anatomical abnormalities (46% of glands in ectopic locations, 12% of supernumeray glands) and multiglandular pathologies (56% of hyperplasias) were much more frequently encountered. Long term results were satisfactory in patients explored for the first time (98% cures) and in reoperations after Tx (94% cures), but were less favourable in reoperations after PTx (78% cures).

Adult↗

PubMed1993

[Technical problems in reoperation of hip joint prostheses].

At the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in the course of 10 years (1979-1989) 2340 primary implantations of total endoprostheses of the hip joint were performed. During the same period 168 total endoprostheses of the hip joint and 20 cervico-occipital prostheses were reoperated. The most frequent reason for reoperation was aseptic loosening of the acetabular component. The mean period between operation and reoperation in these patients was 98 months. In the group with loosening of the socket associated with mechanical destruction of the component the mean period which had elapsed since the primary operation was 43 months. In 87% small size sockets were involved. The most serious problem of reoperation of total endoprostheses of the hip joint is replacement of bone defects. During reoperation of acetabular components an isolated defect on the floor of the acetabulum was found in 26%, a defect of the margins in 38% and a combined defect of the margins in 26% of the patients. For treatment of the defects the authors used bone grafts in the majority allogenic grafts were involved which were used to reconstruct the margins and floor of the acetabulum. Metal implants should hold the bone grafts in the desired position and should not serve as a skeleton. Reoperation of the acetabular part of total endoprostheses of the hip joint is easier from the technical aspect; in defects of the upper portion of the femur it is essential to use a very careful procedure and to preserve the skeleton to a maximal extent.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1997

Left thoracotomy for reoperative revascularization of the posterior coronary circulation.

Reoperative sternotomy for repeat coronary artery revascularization is known to have increased morbidity and mortality when compared to first time sternotomy. The increased risk involve damage to the heart itself, injury to previously placed bypass grafts, embolization of debris from manipulation of diseased grafts leading to possible myocardial infarction as well as the numerous other hazards which may complicate a difficult reoperative dissection. The use of the left thoracotomy for reoperative revascularization of the left thoracotomy for reoperative revascularization of the posterior coronary circulation avoids to the usual hazards of reoperative sternotomy. This approach allows for easy access to the posterior circulation not only for vein graft placement but also for the use of the mammary artery for grafting when necessary. Through the use of an illustrative case report and the discussion of previously reported cases the technique of the procedure as well as its variations and applications is described. The technique of left thoracotomy for reoperation revascularization in selected cases represents a useful alternative in the armamentarium of cardiac surgeon.

Coronary Artery Bypass↗

PubMed1979

Prosthetic aortic valves. Indications for and results of reoperation.

During a 15-year period from January 1962 through December 1976, 42 patients who had undergone a previous aortic valve replacement underwent reoperation. The mean interval between operations was 4.4 years. The indications for reoperation were aortic regurgitation resulting from mechanical malfunction (12 patients), ball variance (15 patients), perivalvular leaks (five patients), prosthetic stenosis (eight patients), anemia (one patient), and recurrent emboli (one patient). The indications were characteristic of a specific valve series. The most common reoperation was aortic valve replacement (29/42), which had a 10.3% operative mortality. Poppet change (10/42) carried a 10% operative mortality and no operative deaths followed suture closure of perivalvular leaks. Eighty-eight percent of patients alive six months after reoperation were New York Heart Association functional class 1 or 2. At last follow-up, 95% of surviving patients were still functional class 1 or 2, with a mean cumulative survival of 4.7 years after reoperation. This experience demonstrates that those patients surviving long enough to undergo reoperation can expect a reasonable operative risk, long-term survival, and excellent clinical improvement.

Anemia↗

PubMed1978

Reoperation after lumbar intervertebral disc surgery.

This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.

Adult↗

PubMed1977

Reoperations for myocardial revascularization.

Reoperations solely for myocardial revascularization were performed in 219 consecutive patients (1967 to 1975). Indications were (1) graft failure, 46 (21 per cent); (2) progressive atherosclerosis, 42 (19 per cent); (3) incomplete revascularization, 39 (18 per cent); and (4) combinations, 92 (42 per cent). Primary operations included bypass grafts in 100 patients; mammary artery implants, 87; and combinations of direct and indirect procedures, 32. Reoperations performed were single bypass, 141 patients; double, 61; and triple or other coronary artery operations, 17. Eight patients died within 30 days of operation (3.7 per cent). Major postoperative complications included hepatitis, 24 (11 per cent); myocardial infarction, 19 (9 per cent); bleeding, 21 (10 per cent); and respiratory insufficiency, 12 (5 per cent). Follow-up for 202 long-term survivors was complete (mean 29 months). In patients who originally underwent direct revascularization, Class I or II (N.Y.H.A.) was attained in 35 of 43 (81 per cent) of those reoperated upon for primary graft failure, in 14 of 15 (93 per cent) of those with progressive atherosclerosis, and in 27 of 33 (82 per cent) of patients with combined indications. Arteriography was performed after the reoperation in 55 patients (mean interval 17 months), and 65 of 77 (84 per cent) grafts were patent. Nineteen of 22 grafts performed for primary graft failure were patent. We have made the following conclusions: (1) Reoperation for direct myocardial revascularization can be accomplished with low mortality rates although morbidity is high; (2) complete relief of symptoms was achieved in 65 per cent of survivors; (3) results in patients reoperated upon for graft failure alone were similar to results in those operated upon for progressive atherosclerosis or combined indications; and (4) high graft patency was found in secondary grafts constructed to arteries involved with primary graft failure.

Adult↗

PubMed1988

Hancock bioprosthetic valve failure: causes, and results of reoperation.

Between March 1970 and the end of December 1986, 180 porcine valve recipients underwent reoperation at our institution because of bioprosthetic failure. Of these patients, 126 (70.0%) had mitral bioprosthesis replacement (MBR), which was necessitated because of primary tissue failure in 107 cases, prosthetic valve endocarditis in eight cases, and paravalvular leakage in eleven cases. Forty-six patients (25.5%) had aortic bioprosthesis replacement (ABR), owing to primary tissue failure in 37 cases, endocarditis in six cases, and paravalvular leakage in three cases. The remaining eight patients (4.5%) all underwent double (mitral and aortic) bioprosthesis replacement (DBR) because of primary tissue failure. In a total of 152 patients who underwent reoperation for primary tissue failure, the hospital mortality was 6.5% for the MBR group, 8.0% for the ABR group, and 0% for the DBR group (mean, 6.5%). In those 14 patients who required reoperation owing to endocarditis, the hospital mortality was 75% for the MBR group and 50% for the ABR group (mean, 64%). In another 14 patients who underwent reoperation because of paravalvular leakage, the hospital mortality was 9% for the MBR group and 0% for the ABR group (mean, 7%). Morphologic studies of the explanted valves revealed that tissue calcification is the most frequent cause of primary tissue failure in Hancock-valve recipients. Calcification leads to cusp stiffening with stenosis or to cuspal and commissural rupture with incompetence. Usually, primary tissue failure causes progressive dysfunction that allows for elective reoperation, which is associated with a low mortality; rarely, however, porcine xenograft failure can occur acutely and require emergency operation, which is associated with a significantly higher risk. Such operation was necessary in nine (6%) of our patients with primary tissue failure and resulted in four deaths (44%); conversely, elective reoperation was done in 143 patients with other primary tissue failure (94%) and resulted in six deaths (4%) (p<0.001). Our long-term experience with the Hancock bioprosthesis confirms that this valve's durability is limited. Therefore, we believe that the indications for the use of porcine bioprostheses should be restricted, until consistent data become available concerning the durability of the new generation of prosthetic valves.

Journal Article↗

PubMed1999

Laparoscopic reoperation for failed antireflux procedures.

BACKGROUND: Laparoscopic fundoplication has become the criterion standard for the surgical treatment of gastroesophageal reflux disease. Recently, several patients were referred with recurrent symptoms of gastroesophageal reflux disease or severe dysphagia following previous antireflux surgery for possible laparoscopic reoperation. HYPOTHESIS: To determine the safety and efficacy of this procedure. DESIGN: Case series, consecutive sample. SETTING: University-affiliated and community tertiary care hospitals. PATIENTS: Prospective study of 27 consecutive patients undergoing attempted laparoscopic reoperation for symptoms of recurrent gastroesophageal reflux disease or intractable dysphagia following antireflux surgery. Patients were available for follow-up for 1 to 60 months postoperatively. INTERVENTIONS: All patients underwent preoperative workup and attempted laparoscopic reoperation for treatment of symptoms. MAIN OUTCOME MEASURES: Data were collected on preoperative symptoms and evaluation, operative time, blood loss, time to regular diet, length of hospitalization, morbidity, mortality, and long-term results. RESULTS: Twenty-six patients underwent successful laparoscopic operations, with no mortality and minimal morbidity. One patient underwent conversion to open laparotomy and then developed a proximal gastric leak, which was treated conservatively. Twenty-four patients began a liquid diet by postoperative day 1, and most were discharged from the hospital by postoperative day 3. One patient required dilation for postoperative dysphagia. The remaining patients are doing well and none have required treatment with acid-reducing medication. CONCLUSIONS: Although technically challenging, laparoscopic reoperation for recurrent gastroesophageal reflux disease can be performed safely and with excellent results. In the hands of experienced endoscopic surgeons, patients who have undergone unsuccessful antireflux surgery should be offered laparoscopic reoperation.

Adolescent↗

PubMed2001

Localization and reoperation results for persistent and recurrent parathyroid carcinoma.

HYPOTHESIS: Reoperation is safe and benefits patients with persistent and recurrent parathyroid carcinoma. DESIGN: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). SETTING: A university tertiary referral center. PATIENTS: Eighteen patients treated for parathyroid carcinoma from 1966 to 1999. RESULTS: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent parathyroid carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation for parathyroid carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (P<.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but not extent of initial resection, PTH level, time to recurrence, concordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hypoparathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sensitivity rates of sestamibi scan (n = 14), magnetic resonance imaging (n = 15), computed tomographic scan (n = 6), ultrasound (n = 13), and selective venous catheterization with PTH measurement (n = 6) were 79%, 93%, 67%, 69%, and 83%, respectively. CONCLUSIONS: Recurrence is common in patients with parathyroid carcinoma. Patients with this disease should have frequent, lifelong follow-up to ensure early detection of recurrence. Although reoperation for persistent or recurrent parathyroid carcinoma provides significant symptomatic relief and normalizes serum calcium and PTH levels in most patients, it is associated with some morbidity. Localizing studies of parathyroid carcinoma are helpful but do not detect all tumor foci.

Adult↗

PubMed1987

Treatment of cervical disc disease using Cloward's technique. Part V. The effect of reoperations.

Among 1,106 patients with cervical disc disease in whom Cloward's operation had been performed over a fifteen-year period, 145 patients were reoperated upon with a new Cloward procedure. In the 1st year after the first operation 3/4 of the patients were operated upon on the previous level, whereas reoperations performed later mainly were done on new levels. The effect of the reoperation was poorer than the effect of the 1st operation. Early reoperations--which were due to: an initially unsatisfactory clinical course, postoperative complications or graft problems--had a poor result, but late reoperations--which were caused by relapses--showed a result corresponding to the first operation. The frequency of relapses leading to a 2nd Cloward operation was 8.8% in the first year falling to 0.2% in the following years of observation.

Cervical Vertebrae↗

PubMed1994

Role of angioscopy in reoperation for the failing or failed infrainguinal vein bypass graft.

The purpose of this retrospective study is to review our ongoing experience with the use of angioscopy during reoperation for failed or failing infrainguinal vein bypass grafts and define the role of angioscopy in the management of this clinically demanding patient group. All hospital records, arteriograms, and intraoperative angioscopic video recordings of 79 consecutive failed or failing grafts (76 patients) examined with angioscopy during reoperation between 1987 and 1993 were reviewed. Clinical and intraoperative data, comparison of the preoperative arteriogram and intraoperative angioscopic findings, and surgical decisions or interventions resulting from the additional angioscopic findings were collated and analyzed according to a predetermined protocol. Sixty-six additional angioscopic findings were noted during the 79 reoperations and resulted in 61 additional interventions and surgical decisions with salvage of all or part of the graft in 90.9% in the early (< 30 day) failed (group 1), 84.6% in the late (> 30 day) failed (group 2), and 90.3% in the late (> 30 day) failing grafts (group 3). The amount of residual thrombus within the graft, as assessed by angioscopy after all interventions, was the critical determinant for overall early graft patency (p < 0.001) and long-term patency for all the subgroups after reoperation (group 1, p < 0.001; group 2, p = 0.0016; and group 3, p = 0.0194). Intraoperative angioscopy has an important role in these challenging procedures. It provides additional and useful information that not only influences the conduct and extent of the reoperative surgery but may provide insights into the pathogenesis of graft failure.

Adult↗

PubMed1998

Complications requiring reoperation following pancreatectomy.

CONCLUSIONS: In this series, the overall reoperative rate following pancreatic surgery is 9%. Complications following pancreatectomy that require reoperation fall into four categories: hemorrhage, infectious, delayed gastric emptying, and anastomotic leak. A delay in the management of these types of complications can be fatal. BACKGROUND: Despite the improvement in the morbidity and mortality rates associated with pancreatic resection, complication still arise that require surgical intervention. This study reviews the pancreatic surgical experience at a major medical center to determine the overall reoperative complication rate. STUDY DESIGN: From 1985 to 1995, 107 patients underwent pancreatic resection. There were 50 pancreaticoduodenectomies, 20 total pancreatectomies, and 37 distal pancreatectomies for 102 periampullary or pancreatic cancers and five for chronic pancreatitis. The operative mortality rate was 6.5% and the morbidity rate was 43%. Ten patients (9%) developed complications that required reoperation. RESULTS: Re-exploration was performed in five patients for hemorrhage. Four patients had bleeding intra-abdominally and one had a suture line bleed. One patient developed a wound infection and fascial necrosis which necessitated reoperation. Three patients were explored for sepsis and one was found to have a pancreatic leak. One patient had persistent gastric outlet obstruction and he required conversion of the gastrojejunostomy to a Roux-en-y anastomosis. The mortality rate for re-exploration was 3/10 (30%).

Humans↗

PubMed2001

Mycotic aneurysm of common carotid artery induced by Staphylococcus aureus infection after cervical reoperation.

The objective of this study was to define a novel type of mycotic aneurysm of the carotid artery arising after cervical reoperation. We retrospectively analyzed all staphylococcal mycotic aneurysms of the common carotid artery. These aneurysms had developed after reoperative thyroid or parathyroid surgery, including resection of the central lymph node compartment and cervical reexploration. Mycotic aneurysms were found in three patients, with an incidence of 0.77% (2/261) and 0.62% (1/161) for thyroid and parathyroid reoperations, respectively. Postoperatively, a lymphatic fistula and cervical hematoma emerged in all patients, as did cervical wound infections on days 3, 4, and 6. Deep wound infections were noted on surgical revision. Cultures grew exclusively Staphylococcus aureus, which was resistant to methicillin (MRSA) in one patient. Mycotic aneurysms were identified 1 week after cervical reoperation. One aneurysm was discovered incidentally on planned lavage. The other two aneurysms presented as severe arterial hemorrhages, resulting in exsanguination in one patient. The other two patients had their aneurysms replaced by saphenous venous autografts. There seems to be accelerated arterial media destruction with formation of mycotic aneurysms in staphylococcal wound infections after cervical reoperation. It is important to recognize this novel type of mycotic aneurysm, as it must be repaired immediately to anticipate imminent rupture.

Adult↗

PubMed2005

[Reoperation in carpal tunnel syndrome. Retrospective analysis].

BACKGROUND: The goal of this study was the reexamination, description, and analysis of postoperative results after carpal tunnel release reoperation. PATIENTS AND METHODS: Thirty-eight patients were examined retrospectively 2 years after reoperation of carpal tunnel release. All of them had had complaints after the first operation. On the basis of DASH and Amadio questionnaires after the reoperation, the patients were divided into two groups: good results and inadequate results. RESULTS: The reasons for reoperation included incomplete division of the retinaculum, early fibrosis, reoccurrence, late fibrosis, intraoperative complication, and one unclear situation. A quarter of the patients were free of complaints; three quarters had symptoms in which sensation improved but strength and function did not. CONCLUSION: The clinical findings showed satisfying results for the patients. Reoperation is indicated after early postoperative deterioriation or if there is no improvement.

Carpal Tunnel Syndrome↗

PubMed1996

[Correction and reintervention in carpal tunnel syndrome. Report of 185 reoperations].

The outcome of 185 reoperations between 1986 and 1995 could be grouped into three categories: 1. In 91 cases (49.2%) the retinaculum was not fully divided (in most cases distally) or was completely intact. Most of these patients presented atypical incisions and deterioration of distal motor latency as well as worsening of the clinical symptoms. 2. In 58 cases (31.4%) true recurrences were present. Forty-five of these patients received chronic haemodialysis. 3. In 36 cases (19.5%) the reoperation proved unnecessary. In ten of them iatrogenic nerve damage was found. Five patients were assumed to have spontaneous intraneural bleeding following decompression of the highly compressed nerve with prolonged recovery. Other cases presented additional symptoms of radicular compression ("double crush syndrome"), especially when the electroneurographic findings were discrete or could not be compared with preoperative values. With regard to these experiences, reoperation is indicated when symptoms of median nerve compression persist, especially when an atypical incision is present and distal motor and sensory latency has increased. True recurrences are rare, except in patients undergoing chronic haemodialysis. Reoperation has proved to be less successful in patients presenting atypical signs and symptoms, e.g. dysaesthesia following the first operation, which is rather typical for nerve damage, or a double crush syndrome. Exploration is also not indicated in patients suffering from tender scars. Since additional intraneural neurolysis is unnecessary, reoperations can be performed under local anaesthesia in bloodless field.

Adult↗