SEARCH · PubMed Health

Results for “Reoperation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed1992

Factors affecting mitral valve reoperation in 317 survivors after mitral valve reconstruction.

From a very heterogeneous group of 340 patients undergoing mitral valve reconstruction from 1969 through 1988, 313 hospital survivors were analyzed for factors affecting the occurrence of reoperative mitral valve procedures related to native mitral valve dysfunction. Follow-up was 100% and extended from 1 year to 20 years (mean follow-up, 7.2 years). Sixty-three patients (18.5% of the 340) required mitral valve reoperation at a mean postoperative interval of 6 years (range, 1 to 15 years). Incremental risk factors analyzed for the event late mitral valve failure included age, sex, preoperative New York Heart Association class, cause of valvular disease, pathophysiology of the mitral valve, previous mitral valve operation, mitral valve pathology, and estimation of mitral valve function at operation after repair. Mitral valve pathophysiology affected the actuarial freedom from mitral valve replacement (p = 0.023 [log-rank]). Actuarial freedom from mitral valve reoperation was 90% at 5 years and 80% at 8 years in patients who had either pure mitral regurgitation or isolated mitral stenosis compared with 80% and 72% at 5 and 10 years, respectively, in patients who had mixed mitral stenosis and regurgitation (p = 0.023). Patients undergoing late reoperation were younger (51.7 +/- 1.56 years [+/- the standard error of the mean]) than those not having reoperation (p less than 0.0003). Durability of the repair was less in patients with rheumatic heart disease (p less than 0.025) and greater in patients with ischemic heart disease (p less than 0.004). Seventy-three percent of patients undergoing reoperation had concomitant operations compared with 68% of those not having reoperation (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Reoperations after operation on the thoracic aorta: etiology, surgical techniques, and prevention.

Recurrent aortic aneurysms, persistent or new dissection, new onset of valvular and coronary artery disease, graft infection, and prosthetic endocarditis are not rare after thoracic aortic operations; they can be difficult to diagnose and represent a formidable surgical challenge. Between 1977 and 1991, 876 operations were performed on the thoracic aorta in our institution: 340 in dissections, 299 in true aneurysms, 150 for aortic remodeling and external wall support during aortic valve replacement, and 87 for miscellaneous causes. During the same period, there were 193 additional reoperations. Vascular reoperations on abdominal aorta and peripheral arteries accounted for 73 cases and are not further discussed in this study. The reasons for reoperation (n = 130) in 120 patients were: failure of biologic valves (n = 23); aneurysm recurrence in a proximal or distal aortic segment (n = 21); pseudoaneurysm formation at suture lines (n = 13); new dissection or dilatation involving ascending aorta (n = 11), aortic arch (n = 13), and descending aorta (n = 10); aneurysm after aortic remodeling (n = 13); new onset of valvular disease (n = 5); and new onset of coronary disease (n = 5). Infected aortic graft and prosthetic endocarditis accounted for 10 reoperations, and a planned two-staged procedure was performed in 6 patients. Omitting the failed biologic valves, reoperations were performed on the aortic segment previously operated on in 69.3% of the cases and on other thoracic segments in 30.7%. Overall hospital mortality rate after reoperation was 5.8%. A significant decrease in operative mortality was observed in the most recent period (3.0% between 1989 and 1991). Reoperations are technically demanding, and some of them are preventable; therefore (1) graft inclusion technique should be abandoned in ascending aortic operation due to formation of false aneurysms; (2) in patients with Marfan syndrome, complete repair of the diseased aorta should be attempted during the initial operation; (3) aortic arch dissection should be repaired definitively during the first operation in low-risk patients; (4) biological valves should be avoided in aneurysm operations; and (5) homograft replacement is the treatment of choice in prosthetic endocarditis or in infected composite graft after an aortic valve or ascending aortic operation.

Actuarial Analysis↗

PubMed2006

Risk-adjusted rates for potentially avoidable reoperations were computed from routine hospital data.

OBJECTIVES: Reoperations may reflect a suboptimal initial surgical treatment. The study aimed to develop a screening algorithm for those potentially avoidable, using only routinely collected hospital data and a prediction model to adjust rates for case-mix. STUDY DESIGN AND SETTING: Data of a 3-year random sample of 7,370 therapeutic operations on inpatients, among which 833 were followed-up by a reoperation during the same stay. A review of medical records identified clearly avoidable and other potentially avoidable reoperations to develop and test the screening algorithm. A logistic prediction model of potentially avoidable reoperations was developed on one randomly chosen half of the data (about 9,000 interventions) and tested on the other half (cross-validation). RESULTS: Two hundred thirty-seven interventions (3%) were followed by a potentially avoidable reoperation, among which 144 were clearly avoidable. The screening algorithm had a sensitivity of 75% and a specificity of 72%. Predictors of potentially avoidable reoperations were surgery categories, diagnosis related conditions, and experiencing prior surgery. The risk score, based on these variables, showed at once a satisfactory discriminative performance (C-statistic=0.76) and goodness-of-fit measure on the validation set. CONCLUSION: The adjusted rate of potentially avoidable reoperations should be included in internal reporting of hospital quality indicators, but further validated in various settings.

Adult↗

PubMed2006

Reoperation is not an independent predictor of mortality during aortic valve surgery.

OBJECTIVE: Reoperations on aortic valves are associated with increased mortality, which may affect valve prosthesis selection at the time of initial aortic valve replacement. We analyzed our experience to determine whether reoperation itself independently predicts mortality during aortic valve surgery. METHODS: Demographic, intraoperative, and outcome data were collected prospectively on patients undergoing primary or redo aortic valve replacement or Bentall procedures after previous aortic valve replacement with or without concomitant coronary bypass grafting at a single institution from 1990 through 2002. Logistic regression analyses validated by means of bootstrap methodology identified the predictors of hospital mortality and the independent effect of reoperation. RESULTS: Of 2673 patients undergoing aortic valve surgery, 2375 were primary operations, 216 were reoperations, and 82 were Bentall-after-aortic valve replacement procedures. Of 298 reoperations, 32 were third and 5 were fourth procedures. Mortality was 2.3% for primary operations, 4.6% for redo aortic valve replacement, and 2.4% for Bentall-after-aortic valve replacement procedures. Most patients underwent elective procedures, with mortalities of 1.6%, 1.7%, and 2.5%, respectively. Hospital mortality was independently predicted by peripheral vascular disease (odds ratio, 3.6), active endocarditis (odds ratio, 2.9), worsening New York Heart Association class (odds ratio, 2.3), and need for annular enlargement (odds ratio, 2.1). Reoperation itself did not predict hospital mortality. CONCLUSIONS: The risk of mortality during aortic valve surgery is due mostly to active endocarditis, New York Heart Association class, and comorbidity. We failed to find a significant effect of reoperation on perioperative mortality. Mechanical valves, with their attendant anticoagulation-related morbidity, should not be implanted solely because of anticipated high mortality associated with bioprosthetic rereplacement.

Aged↗

PubMed2002

How to diminish reoperation rates after initial repair of tetralogy of Fallot?

BACKGROUND: Complete correction of tetralogy of Fallot has good long-term results. Right ventricular outflow tract obstruction and pulmonary insufficiency occur which require reintervention. The present study evaluated the efficacy of reoperation following complete correction of tetralogy of Fallot, the sites of recurrences and impact of techniques used at first operation. METHODS: Between 1980 and 1999, 501 patients underwent complete correction of tetralogy of Fallot. Reoperation rate was 7.4%. Residual or recurrent right ventricular outflow tract stenosis was seen in 25 patients (68%), and 7 patients (19%) had severe pulmonary insufficiency. Age at redo was 9.1+/-6.4 years. Restenosis was most frequently observed (75%) at the bifurcation of the pulmonary artery. Extended 1-patch enlargement was used until 1989 and thereafter changed to a 2-patch technique. RESULTS: Valvar-supravalvar 1-patch technique had a redo rate of 33.3%, compared with 4.3% for the 2-patch technique, p = 0.0264, with excellent freedom from reoperation rate. At reoperation right ventricular-pulmonary artery (RV-PA) conduits managed 29 patients and 3 had supravalvar patch enlargement. Hospital mortality was 5.4% (2 of 37). Twenty-five patients (68%) were in New York Heart Association functional class I to II at end of the follow-up, and none required further interventions. CONCLUSIONS: Redo rate following complete correction of tetralogy of Fallot was 7.4%. Right ventricular outflow tract pathology was the dominant reason for reoperations (86%). At reoperation, RV-PA conduits was the most frequently used technique. Reoperation was efficient in reducing the RV-PA gradient, had low hospital and late mortality. A 2-patch valvar-supravalvar enlargement at first operation reduced the risk for redo in long-term follow-up.

Adolescent↗

PubMed1999

Reoperative pulmonary thromboendarterectomy.

BACKGROUND: Recurrent symptomatic pulmonary hypertension is uncommon after primary pulmonary thromboendarterectomy (PTE). We reviewed our experience with patients undergoing repeat PTE to determine the risk factors for recurrent disease, and the selection criteria, relative risks, and functional outcomes of reoperative PTE. METHODS: Since 1990, 13 of 870 (1.5%) patients underwent reoperative PTE at our institution. These 7 men and 6 women (mean age 38.6 years) were contrasted with the most recent 225 patients (111 men, 114 women, mean age 52.7 years) who underwent primary PTE for whom complete hemodynamic data are available. The preoperative evaluation of all patients was similar. Pulmonary hemodynamic data and outcome measures were compared between groups. RESULTS: Of 13 reoperated patients: 69% (9/13) had their primary operation at another institution, 54% (7/13) initially underwent unilateral PTE, 38% (5/13) had identifiable coagulation disorders, 38% (5/13) had ineffective caval filtration, 31% (4/13) had suboptimal anticoagulation management, and 31% (4/13) had complete unilateral pulmonary artery obstruction. The mean interval to reoperation was 5.2 years (range 0.7 to 10.9 years). All control patients underwent bilateral PTE using hypothermic circulatory arrest. Operative mortality was 7.7% (1/13) with reoperation vs 8.4% (19/225) in controls. No difference (p = NS) was observed between groups in the preoperative pulmonary artery pressure (PAP) or pulmonary vascular resistance; however, the control group had a significantly (p < 0.05) greater reduction in the postoperative PAP (46/19, mean 28 mm Hg vs 59/23, mean 35 mm Hg) and PVR (271 +/- 172 vs 399 +/- 154 dynes/s/cm(-5)) compared with the redo group. No substantial difference in morbidity or functional outcomes was observed between groups. CONCLUSIONS: Reoperative PTE can be performed with a perioperative risk comparable with primary PTE, although the improvement in pulmonary hemodynamics is not as favorable. Bilateral primary operation, effective caval filtration, and vigilant anticoagulant management would prevent the need for most reoperative PTEs.

Adult↗

PubMed1999

Reoperation in adults with repair of tetralogy of fallot: indications and outcomes.

OBJECTIVE: The purpose of this study is to review indications, surgical procedures, and outcomes in adults with repaired tetralogy of Fallot referred for reoperation. METHOD: Sixty consecutive adults (age >/= 18 years) who underwent reoperation between 1975 and 1997 after previous repair of tetralogy of Fallot were reviewed. Mean age at corrective repair was 13.3 +/- 9.6 years and at reoperation 33.3 +/- 9.6 years. Mean follow-up after reoperation is 5.0 +/- 4.9 years. RESULTS: Long-term complications of the right ventricular outflow tract (n = 45, 75%) were the most common indications for reoperation: severe pulmonary regurgitation (n = 23, 38%) and conduit failure (n = 13, 22%) were most frequent. Less common indications were ventricular septal patch leak (n = 6) and severe tricuspid regurgitation (n = 3). A history of sustained ventricular tachycardia was present in 20 patients (33%) and supraventricular tachycardia occurred in 9 patients (15%). A bioprosthetic valve to reconstruct the right ventricular outflow tract was used in 42 patients. Additional procedures (n = 115) to correct other residual lesions were required in 46 patients (77%). There was no perioperative mortality. Actuarial 10-year survival is 92% +/- 6%. At most recent follow-up, 93% of the patients are in New York Heart Association classification I or II. Sustained ventricular tachycardia occurred in 4 patients (7%) during follow-up. CONCLUSIONS: Long-term complications of the right ventricular outflow tract were the main reason for reoperation. Mid-term survival and functional improvement after reoperation are excellent.

Adolescent↗

PubMed1997

Results of reoperation after failed modified condylotomy.

PURPOSE: This retrospective study reports the reoperation rate for failure after modified condylotomy. MATERIALS AND METHODS: A consecutive series from each of two surgeons constituted the study group of 361 joints in 235 patients. Reoperation rates were calculated for all joints and by type of disc displacement. RESULTS: A second operation occurred in 4.2% of all joints. However, the cumulative rate of reoperation was 4.4%, because one of the joints required a third operation. Although the rate of reoperation varied (0% to 6.5%) according to the type of disc displacement, the differences were not statistically significant. All joints requiring reoperation had a displaced disc, and more than half had lost nearly all the joint space gained by the primary operation. CONCLUSION: The rate of reoperation for modified condylotomy is low. Risk factors for reoperation appear to be recurrent or residual disc displacement and loss of joint space after the first operation. Bilateral operation was not a risk factor.

Adolescent↗

PubMed2003

Coronary reoperations without the use of cardiopulmonary bypass.

BACKGROUND: Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity. MATERIALS AND METHODS: Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3+/-5 and 57.4+/-7.3 years, respectively. RESULTS: Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively. CONCLUSION: Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.

Adult↗

PubMed2000

Predicting outcome after reoperative procedures on the aortic root and ascending aorta.

OBJECTIVE: Reoperations on the ascending aorta after prior aortic procedures are formidable challenges. In order to identify factors predictive of clinical outcome using a uniform surgical approach, results of a 15-year experience were reviewed. METHODS: Between 1983 and 1998, 78 reoperations on the ascending aorta were performed in 71 consecutive patients. There were 56 males and 15 females, aged 54+/-13 years (10-73 years), with a mean interval to first reoperation of 60+/-76 months (5-223 months). The original operation was replacement of ascending aorta (23), aortic valve (25), aortic root (7), ascending aorta with valve preservation (9), ascending aorta and aortic valve (7). Surgical approach included femoral vessels dissection and repeat sternotomy, with femoro-femoral bypass limited to cases of traumatic reentry. Reoperation consisted in replacement of the aortic root (48), ascending aorta (15), ascending aorta and aortic valve (6), aortic root with ascending aorta and arch (6), ascending aorta and aortic arch (3). Average aortic crossclamp and cardiopulmonary bypass times were 122+/-86 and 188+/-60 min, respectively. RESULTS: Early deaths were five (7%), due to low output syndrome (3), hemorrhage (1) and sepsis (1). Mortality for emergent reoperation was significantly higher (38 vs. 3%, P=0.001). A total of 39 early complications were observed in 78 reinterventions (50%), including: traumatic reentry requiring emergent femoro-femoral bypass (4), reexploration for bleeding (4), respiratory failure (12), sepsis (5), transient neurologic dysfunction (4), renal failure (3), myocardial infarction (3), circulatory insufficiency requiring mechanical life support (2), and wound infection (2). Average intensive care unit stay was 4.5+/-9.7 days (0.5-40 days). Survival was 92+/-4%, 78+/-10% and 78+/-10% at 1, 5, and 10 years, respectively. At follow-up (mean 34+/-36 months, 1-170), survivors were in satisfactory clinical conditions (1.6+/-0. 8 mean NYHA class, 1-3) with no evidence of renal, respiratory or neurologic dysfunction. Multivariable analysis showed emergent reoperation (P=0.001), prior aortic valve replacement (P=0.005) and need for arch replacement (P=0.03) to be predictive of higher operative mortality. Longer duration of bypass (P=0.01) and aortic arch replacement (P=0.04) were predictive of higher prevalence of postoperative complications. CONCLUSIONS: Reoperations on the ascending aorta via repeat sternotomy without preventive femoral bypass are associated with low operative risk and high prevalence early complications. Emergent reintervention due to aortic dissection, particularly in patients with prior aortic valve replacement, and need for arch repair are predictive of poorer perioperative outcome. Long-term outlook of hospital survivors is satisfactory.

Adolescent↗

PubMed1999

Twenty-four year experience with reoperations after ascending aortic or aortic root replacement.

OBJECTIVE: A retrospective analysis of early and late outcome for late (>4 weeks) reoperations on the ascending aorta or aortic root. MATERIALS AND METHODS: During a 24-year interval, starting in 1974, 834 patients underwent replacement of the ascending aorta (39.2%) or aortic root (60.8%). During the same period, 56 patients with a mean age of 51.1 +/- 14.4 years underwent reoperation after ascending aortic or aortic root replacement. Predominant indications for reoperation were false aneurysm in 25 (44.6%) patients and true aneurysm in 18 (32.1%) patients. Most frequent surgical procedures were redo aortic root replacement in 30 (53.6%) patients and closure of a false aneurysm in 14 (25.0%) patients. Median interval between the operations was 51 months. Eighteen (32.2%) patients underwent concomitant partial or total aortic arch replacement. RESULTS: Hospital mortality was 5.4% (n = 3; 70% CL: 2.4-8.4%). Cause of death was low cardiac output in two patients and rupture of the aorta at the distal suture line in one patient. Univariate analysis identified two or more previous operations (P = 0.038) and the interval between initial operation and reoperation for complication of less than 8 months (P = 0.005) as risk factors for hospital death. Multivariate analysis indicated operation for active endocarditis or vascular graft infection as an independent risk factor for hospital death (P = 0.038, odds 14.6). Follow-up was complete, median 3.1 years. Nine (16.9%; 70% CL: 11.7-22.1%) patients died during that period. Estimated survival at 1, 5 and 10 years was 91.2, 84.0 and 76.4%. One patient underwent another reoperation. Estimated event-free survival at 1, 5 and 10 year is 84.3, 72.2 and 65.6%. CONCLUSION: False aneurysm formation and progression of aneurysmatic disease are the predominant causes for late reoperations after aortic root or ascending aortic replacement. Reoperations can be performed with low hospital mortality and good late results.

Adult↗

PubMed1995

Late reoperation in vascular surgery.

OBJECTIVES: Assessment of late reoperation (after 30 days) following vascular surgery. DESIGN: Analysis of a prospectively collected database of consecutive patients undergoing vascular surgery. SETTING: A single teaching unit's experience between 1986-1993. MATERIALS: Patients undergoing 2501 primary arterial reconstructions. CHIEF OUTCOME MEASURES: Reoperation after 30 days. MAIN RESULTS: One hundred and fifty eight patients (6%) underwent further operations, at more than 1 month after the primary procedure. Primary procedures at highest risk for reoperations were axillobifemoral bypasses and femorodistal bypasses with respective late reoperation rates of 20% and 16%. The majority of patients required late reoperation because of graft occlusion or stenosis. Overall, of the 158 late reoperations performed, 114 were related to the same arterial segment with the same presenting symptoms as the primary operation, and 44 for a different indication. A second or subsequent reoperation was required in 54 patients and the overall operative mortality was 11%. CONCLUSION: Patients undergoing certain vascular procedures, should be informed of the high risk of a subsequent procedure when consent is obtained.

Aged↗

PubMed1998

The outcome of reoperation following photorefractive keratectomy.

PURPOSE: The aim of this study was to assess the outcome of reoperation following photorefractive keratectomy related to different techniques. MATERIAL AND METHODS: 265 retreated eyes were divided into 5 groups; low to moderate myopia, high myopia, enlargement, abrasion, and non-compliance. The low to moderate group was further subdivided into 5 categories based on the surgical approach of the reoperation. Outcomes were compared at 12 months after reoperation. RESULTS: There was no statistically significant difference in the median refraction prior to initial PRK, before reoperation, and after reoperation between the 5 categories 66%, of all reoperated patients achieved an uncorrected visual acuity of 0.5 or better after 12 months. 72% had a postoperative refraction between +/- 1 diopter. The other 4 groups were not statistically analyzed due to the wide variety of patients included and non-compliance. CONCLUSION: In low to moderate myopes, approximately 97% achieve uncorrected visual acuity of 0.5 or better following PRK, including one reoperation.

Adult↗

PubMed1998

Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996.

BACKGROUND: Difficulties in obtaining and analysing outcome measures in hernia surgery may be an obstacle to necessary progress in non-specialized hospitals. Against this background a voluntary register was initiated in 1992 with the aim of describing and evaluating hernia surgery in participating units. METHODS: Prospective registration of all hernia operations carried out in participating hospitals was undertaken using identification codes specific for each individual. Repair technique, complications, day surgery, type of anaesthesia, and reoperation for recurrence were recorded. Actuarial analysis was used to determine the cumulative incidence of reoperation. Relative risk for reoperation was estimated by the Cox proportional hazards model. RESULTS: The number of participating hospitals and registered operations increased from eight and 1689 respectively in 1992 to 21 and 4056 in 1996. The use of mesh increased from 7 per cent of all operations in 1992 to 51 per cent in 1996. The proportion of operations done for recurrent hernia remained constant at 16-17 per cent throughout the 5-year study period. For all 12542 herniorrhaphies registered, the cumulative incidence of reoperation at 2 years was 3 (95 per cent confidence interval 3-4) per cent. Postoperative complications, recurrent hernia, direct hernia and absorbable suture were associated with increased risk of reoperation for recurrence. An increased incidence of reoperation, although not statistically significant, was noted for conventional open repairs (Bassini, McVay, Marcy and others) versus the Shouldice technique. CONCLUSION: In this prospective audit an increasing use of mesh was observed for open and laparoscopic surgery, especially for bilateral and recurrent hernia operations. Reoperation rates decreased significantly between 1992 and 1995.

Adolescent↗

PubMed1997

Late survival and predictors of recurrent angina after coronary artery reoperation.

Although coronary artery reoperations are now well established, there is limited information concerning factors predisposing to further recurrent angina after a successful second bypass operation. We have retrospectively evaluated the late (10-year) results, and identified predictors associated with poor long-term outcome, of fifty-seven consecutive patients, mean age 54.8 (SD = 9.7) years, range 43 to 67 years, reoperated on for recurrent angina (RA) between January 1980 and May 1988. Twenty-four factors possibly influencing the probability of further recurrence of angina (FRA) were evaluated, comparing operative survivors who developed FRA with those who remained symptom-free during a complete follow-up study period ranging from 35 to 134 months. Reoperative mortality was 8.7% [95% confidence limits (95% CL) 6.7 to 11%]. Survival analysis (Kaplan-Meier) revealed 94% at 3 (95% CL +/- 7%), 90% at 5 (95% CL +/- 8%) and 83% at 10 years (95% CL +/- 12%). Probability of freedom from FRA was 88%, 73%, and 56% at 1, 5, and 10 years, respectively. Using univariate analysis, female sex (p < 0.05), time between 1st operation and RA (p < 0.005), family history of ischaemic heart disease (IHD) (p < 0.01), obesity (p < 0.001), time between 1st and 2nd operation (p < 0.001), and the non-use of internal mammary artery at reoperation (p < 0.0001) were associated with increased incidence of FRA. Independent risk-factors, by multivariate analysis (Cox's proportional hazards), were: family history of IHD (p = 0.006), triple-vessel disease (p = 0.024), obesity (p = 0.052), and time interval-between 1st and 2nd operation (p = 0.046). We conclude that reoperative surgery results in satisfactory long-term survival and angina-free interval. Patients with a short time interval between reoperations, family history of IHD, obesity, triple-vessel disease, and non-use of internal mammary artery at reoperation are at higher risk of developing further recurrent angina, and, therefore, more likely to require a subsequent revascularisation procedure.

Adult↗

PubMed1995

Pericardial trauma and adhesions in relation to reoperative cardiac surgery.

In an attempt to appreciate the changes that favour adhesion formation we compared the morphological and fibrinolytic changes that occur in human primary and reoperative pericardium. Ten patients undergoing primary elective open heart surgery and ten undergoing first time reoperative open heart surgery were studied. Pericardial samples were taken at four time points. At 0 (time A) and 30 (time B) minutes from the time of pericardiotomy (before the commencement of CPB), 30-50 minutes (time C) after the commencement of CPB, and then finally 10 minutes (time D) after the patient had been rewarmed. The fibrinolytic activity, as measured by the plasminogen activating activity (PAA), in the pericardial samples of the ten primary cases was compared with that in 5 of the reoperative cases. For the primary group, the PAA after 30 minutes of exposure (median 6.65 IU/cm2, range 3.85-11.89 IU/cm2, p = 0.14, n = 10) was not significantly reduced when compared to the initial activity (median 8.74 IU/cm2, range 2.22-17.68 IU/cm2, n = 10). After 30-50 minutes CPB the PAA was significantly reduced (median 3.93 IU/cm2, range 1.5-13.24 IU/cm2, p = 0.028, n = 10) and still reduced after rewarming for 10 minutes (median 3.12 IU/cm2, range 0.88-19.93 IU/cm2, p = 0.047, n = 10). The simultaneous plasma tissue-type plasminogen activator activity showed a significant (p < 0.05) increase after 30-50 minutes bypass with a later decline. The changes in the reoperative pericardial PAA were similar. In addition, the degree of PAA in reoperative pericardium was consistently lower than that observed in primary tissue. The extent of primary pericardial mesothelial damage at times B, C, and D compared with that at time A showed a significant (p < 0.01 for times B, C, and D) increase. Similarly there was a significant worsening of the degree of inflammation. Compared with primary pericardium, the reoperative samples showed a significant (p < 0.01 for times A, B, and C) preponderance of damaged mesothelium at the earlier stages of the operation. It appears that, following the initial bypass surgery, the processes that cause pericardial and mesothelial healing with recovery of PAA compete with those leading to pericardial adhesions and fibrosis. The histological and biochemical outcome seen in reoperative pericardium is the result of these competitive actions.

Adult↗

PubMed1998

Reoperation as surrogate endpoint in hernia surgery. A three year follow-up of 1565 herniorrhaphies.

OBJECTIVE: Analysis of reoperation and recurrence rates three years after repair of groin hernias. DESIGN: Prospective audit by questionnaire and selective follow-up. SETTING: Eight Swedish hospitals. SUBJECTS: All groin hernia operations done during 1992 on patients between the ages of 15 and 80 years. MAIN OUTCOME MEASURES: Postoperative complications, reoperation for recurrence, and recurrence. RESULTS: During 1992, 1565 hernia operations were done. The postoperative complication rate was 8% (125/1565). At 36 months postoperatively 108 recurrences had already been reoperated on, six patients with recurrences were on the waiting list for reoperation and a further 36 recurrences had been detected at follow-up. The interhospital variation in recurrence rate ranged from 3% to 20%. Postoperative complications, recurrent hernia, direct hernia and hospital catchment area over 100000 inhabitants were all factors associated with an increased relative risk of recurrence. CONCLUSIONS: The recurrence rate exceeded the reoperation rate for recurrence by almost 40% which should be taken into account if the reoperation rate is used as the endpoint after repairs of groin hernia. An audit scheme, based on prospective recording, reoperation rate, and (periodic) calculation of the recurrence rate may be used to identify risk factors for recurrence and areas in need of improvement.

Adolescent↗

PubMed2001

Reoperation after recurrent groin hernia repair.

OBJECTIVE: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia. METHODS: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model. RESULTS: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia. CONCLUSIONS: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.

Hernia, Inguinal↗