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PubMed2000

Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the frequency and categorize the indications for reoperation in three implant systems (Harrington, Cotrel-Dubousset [C-D], and Isola). To define late operative site pain (LOSP) of no apparent cause as an indication for implant removal and determine the success of implant removal in relieving LOSP. SUMMARY OF BACKGROUND DATA: Late operative site pain of no apparent cause has been discussed briefly in the literature but has not been investigated as a major indication for implant removal. METHODS: One hundred eighty-two of 190 consecutive patients with idiopathic scoliosis (96%) who underwent primary surgery between January 1, 1981, and December 31, 1992, by one surgeon in one hospital, with use of Harrington, C-D, or Isola instrumentation were studied an average of 9 years after surgery to determine the indications for and frequency of reoperation. RESULTS: The overall frequency of reoperation for all instrumentation types combined was 19%: Harrington, 19%; C-D, 24%; and Isola, 14%. By 6 years' follow-up the cumulative risk of reoperation by Kaplan-Meier analysis was Harrington, 14%; C-D, 21%; and Isola, 14%. (statistically nonsignificant difference). The most frequent indication for reoperation was LOSP of no apparent cause: 8% (14 patients) for all instrumentation types combined. The average interval between the initial operation and reoperation for LOSP was 46 months (range, 20-97 months). The frequency of each implant type was Harrington, 6%; C-D, 12%; and Isola, 6%. By 6 years' follow-up, the cumulative Kaplan-Meier risk for reoperation due to LOSP was Harrington, 5%; C-D, 13%; and Isola, 8% (statistically non-significant difference). Of the 14 patients who had instrumentation removal for LOSP, 10 (71%) had successful relief of pain after implant removal. CONCLUSIONS: Occurring regardless of implant type, LOSP of no apparent cause after posterior instrumentation of scoliosis is a distinct clinical entity and is relieved by implant removal in most patients.

Adolescent↗

PubMed2004

Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases.

STUDY DESIGN: Retrospective study on the incidence of reoperation in patients previously treated by instrumented posterior lumbar interbody fusion. OBJECTIVES: To answer the following questions: Reoperation rate after PLIF? And is there any influence of the length of fusion on the reoperation rate? SUMMARY OF BACKGROUND DATA: The use of different techniques demonstrates that there is currently no ideal procedure for lumbar fusion. The instrumented posterior lumbar interbody fusion (PLIF) shows a comparable success rate to the so-called 360 degrees fusion techniques (combined dorsoventral spondylodesis) without the need of an anterior approach. METHODS: We reviewed 1680 patients who underwent a PLIF at our institution between January 1995 and December 2000. A total of 3053 levels were fused. The reoperation rate was analyzed. The mean follow-up was 5 years. RESULTS: There were 221 (13.2%) reoperations in 206 patients (12.2%). Of 1680 PLIFs, 312 were multisegmental (>2 segments). Within this group, 45 (14.4%) revisions were done. We found that the most important difference between the multisegmental PLIFs and the mono- or bisegmental PLIFs is the rate of adjacent segment decompensation (5.1% vs. 2.3%), and this was statistically significant. The reoperation rate between those two groups was only slightly different with 12.9% for mono- or bisegmental and 14.4% for multisegmental PLIFs. CONCLUSIONS: The fusion length does not show a significant difference in the reoperation rate as such. Nevertheless, we registered a significantly higher incidence for decompensation of adjacent segments after multisegmental PLIFs.

Female↗

PubMed2004

Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair.

OBJECTIVE: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence. BACKGROUND: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results. METHODS: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis. RESULTS: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation. CONCLUSIONS: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.

Ambulatory Surgical Procedures↗

PubMed1994

Late reoperations in patients with aortic dissection.

Aortic dissection is an evolving process that may require one or several reoperations after the initial emergency repair. From January 1977 to September 1993, 148 patients underwent emergency surgery for type A acute aortic dissection. The replacement of the ascending aorta was extended to include the transverse arch in 43 patients (29%). One hundred fifteen patients (78%) survived surgery. During the same period, 37 patients required reoperation once (28), twice (7), or three times (2), for a total of 48 reoperations. Twenty-one patients had undergone initial repair in our institution; 16 patients had been operated on elsewhere. Reoperation was indicated for: aortic valve disease (4); a new dissecting process (7); threatening aneurysmal evolution of a persisting dissection (34); or false aneurysm (3). The re-do procedure involved: the aortic root and/or ascending aorta in 12 cases (group I); the ascending aorta and the transverse arch in 6 cases (group II); the transverse arch alone in 8 cases (group III); the transverse arch and descending aorta, or the descending aorta alone in 11 cases (group IV); and the thoracoabdominal aorta in 11 cases (group V). Risk factors for reoperation were analyzed in the 115 survivors initially operated on at our institution. Seven of 20 Marfan patients (35%) versus 12 of 95 non-Marfan patients (12.6%) required reoperation (p < 0.02). None of the 31 patients surviving arch replacement at initial repair required a reoperation, versus 21 of 84 (25%) patients surviving replacement limited to the ascending aorta (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Cardiovascular reoperations in Marfan syndrome.

BACKGROUND AND AIM OF THE STUDY: The purpose of this study is to analyze the outcome results of reoperations in Marfan syndrome patients. METHODS: Between 1985 and December 2004, 49 patients with Marfan syndrome were operated for aortic aneurysms. Of these 49 patients, 9 (18,4%) required > or =1 reoperations after a mean duration of 32.2 +/- 26.6 months. The mean duration of follow-up was 52.0 +/- 46.8 months, a total of 39 patient/years. Survival free of reoperation was calculated by Cox regression analysis. RESULTS: Surgical indication for operation was a chronic aneurysmal dilatation of the ascending or abdominal aorta in seven patients (77.8%) and aortic dissection in two (22.2%) at the initial operation. In the reoperations, repair of thoracoabdominal aortic aneurysm with separated graft interposition in six patients (66.7%), replacement of ascending aorta in one (11.1%), replacement of ascending and hemiarchus aorta in one (11.1%), and mitral valve replacement in three patients (33.3%) were performed. The hospital mortality was 11.1% with one patient. Among the survivors, one expired in the follow-up five months after the second operation (12.5%). With the Cox regression analysis, survival without reoperation for 13, 24, and 123 months are 95.56 +/- 3.04%, 90.66 +/- 4.40%, and 60.32 +/- 12.63%, respectively. Mean survival for reoperated patients is 99 +/- 14 months (95% confidence interval 72-127 months). CONCLUSIONS: Reoperations can be done with low morbidity and mortality. Patients should be kept under close follow-up using imaging techniques infinitely.

Adult↗

PubMed1991

The risk of reoperation in patients with bioprosthetic valves.

The risk of operative mortality in patients undergoing a first reoperation for bioprosthetic failure was assessed in a series of patients reoperated upon during the last two decades (1970-1990). A total of 330 such patients underwent replacement of 351 bioprostheses: 88 had aortic; 221 mitral; and 21 mitral and aortic bioprosthetic replacement. Indication for reoperation was in most cases structural valve deterioration (87%), followed by periprosthetic leak (7%) and endocarditis (6%). The operative mortality was significantly higher in patients who preoperatively were in New York Heart Association Functional Class IV or had a lower left ventricular function, in those reoperated because of prosthetic infection, and in those reoperated on an emergency basis. Structural valve deterioration was associated to a substantially low risk; operative mortality has improved in recent years, regardless of the indication for reoperation, partly due to the increasing experience and improved surgical techniques. Our results indicate that in recipients of bioprosthetic valves, careful follow-up with closer surveillance of valve and cardiac function and earlier prosthetic replacement might contribute to reducing the risk of reoperation.

Adolescent↗

PubMed2004

Resective reoperation for failed epilepsy surgery: seizure outcome in 64 patients.

OBJECTIVE: To determine the surgical outcome and factors of predictive value in patients undergoing reoperation for intractable partial epilepsy. METHODS: The authors retrospectively studied the operative outcome in 64 consecutive patients who underwent reoperation for intractable partial epilepsy. Demographic data, results of comprehensive preoperative evaluations, and the seizure and neurologic outcome after reoperation were determined. All patients were followed a minimum of 1 year subsequent to their last operative procedure. RESULTS: Fifty-three patients had two surgeries, and 11 patients had three or more operations. The first surgery involved a lesionectomy (n = 33), "nonlesional" temporal lobe resection (n = 28), and a "nonlesional" extratemporal resection (n = 3). The mean duration between the first and second procedure was 5.5 years. Fifty-five patients underwent an intralobar reoperation, whereas nine had a resection of a different lobe. After reoperation, 25 patients (39%) were free of seizure, 6 patients (9%) had rare seizures, 12 patients (19%) had a worthwhile improvement, and 21 patients (33%) failed to respond to surgery. Predictors of seizure-free outcome were age at seizure onset >15 years (p = 0.01), duration of epilepsy < or =5 years at the time of initial surgery (p = 0.03), and focal interictal discharges in scalp EEG (p = 0.03). Using a logistic regression model, two significant predictors emerged: duration of epilepsy < or =5 years (odds ratio, 3.18; p = 0.04) and preoperative focal interictal discharge (odds ratio, 4.45; p = 0.02). Complications of reoperation included visual field deficits (n = 9), wound infection (n = 2), subdural hematoma (n = 1), and hemiparesis (n = 1). CONCLUSION: Reoperation may be an appropriate alternative form of treatment for selected patients with intractable partial epilepsy who fail to respond to initial surgery.

Adolescent↗

PubMed2002

Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients.

BACKGROUND: 10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach. METHODS: A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m2 (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m2 (range 21 to 52), which increased to 42.7 kg/m2 (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months). RESULTS: 24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m2 (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m2, the weight loss was statistically significant (p < 0.001). CONCLUSION: Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation.

Adult↗

PubMed2002

Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease.

OBJECTIVE: To determine the indications for and spectrum of late reoperations in adults who had previously undergone coarctation repair. PATIENTS AND METHODS: We reviewed clinical, cardiac catheterization, and echocardiographic data and criteria for reoperation, surgical procedures, and outcome in 43 patients who underwent 54 reoperations between 1972 and 1996. RESULTS: Of the reoperations for recoarctation or associated cardiovascular disease (or both), 20% were performed in asymptomatic patients and 80% in symptomatic patients. Associated cardiovascular disease included bicuspid aortic valve in 36 patients (84%), aortic arch hypoplasia in 12 (28%), true or false aortic aneurysm in 6 (14%), mitral valve disease in 6 (14%), and subvalvular aortic stenosis in 5 (12%). Surgical procedures included 22 recoarctation repairs and 32 other cardiovascular interventions. Simultaneous repair of recoarctation and associated cardiovascular disease was performed as a single-stage repair in 5 reoperations through a median sternotomy using an extra-anatomic, ascending-to-descending aortic bypass, with no complications. One patient died (surgical mortality, 1.9%) of preexisting severe pulmonary vascular obstructive disease. CONCLUSIONS: After coarctation repair, associated cardiovascular diseases are the most common cause for reoperation. An individualized surgical approach is important and may range from valve replacement or recoarctation surgery to extra-anatomic bypass combined with other cardiovascular procedures, enabling simultaneous repair of recoarctation and associated lesions. Despite complex surgical techniques and multiple reoperations, morbidity and mortality were low in our series.

Adolescent↗

PubMed2001

Mortality and morbidity in reoperation comparing to first intervention in coronary revascularization.

BACKGROUND: Coronary artery reoperation represents about 20% of coronary artery operations. In this study we compared mortality and morbidity of first intervention and redo operation. METHODS EXPERIMENTAL DESIGN: a retrospective study. SETTINGS: patients who underwent coronary artery reoperations in a University Cardiac Surgery Division in 1991-1994. PATIENTS: our clinical survey was composed of two groups: group A included 44 consecutive patients (mean age 60+/-7 years, males/females=41/3) who underwent a coronary artery reoperation in the years 1991-1994 at the University Cardiac Surgery Division of Turin; group B included 344 patients (mean age 58+/-8 years, males/females=289/55) randomly selected among those who underwent a first coronary operation in the above indicated period of time and centre. All patients had angina pectoris refractory to maximal medical therapy. INTERVENTIONS: all patients underwent a coronary artery operation in extracorporeal circulation (ECC), under mild hypothermia (30-32 degrees C), during a single aortic clamp period, with antegrade cold crystalloid cardioplegia (St. Thomas). MEASURES: comparison of clinical preoperative features, risk factors and postoperative mortality and morbidity between the two groups. RESULTS: In reoperated patients we observed a greater mean akinesis score (p<0.001) and severe left ventricular dysfunction presence (p=0.014). Reoperation mortality was 11.4% against first operation mortality of 3.2% (p=0.03). Female gender (p=0.03), intra-aortic balloon counterpulsation need (p=0.002), adrenaline use (p=0.004) and low cardiac output syndrome (p=0.007) were all perioperative risk factors in group A. CONCLUSIONS: Coronary artery reoperation involves a higher mortality and morbidity compared to the first operation, especially related to the reduced left ventricular function which characterises the population that undergoes reoperation.

Coronary Artery Bypass↗

PubMedDate not supplied

[Early colorectal reoperation: risk factors].

The aim of the study was to analyse the risk factors in colorectal reoperation. Over the period from January 1987 to December 1999, 371 patients (191 male and 180 female, aged from 16 to 88 years) underwent colorectal surgery. Eighteen reoperations (12 male, 6 female, aged from 20 to 74 years; median age: 52.6 years) were performed. These included reoperations performed within 30 days of the first operation (or patient admission). The overall incidence of reoperation after colorectal surgery was 4.8% (18/371). In 14 of 18 patients (77%) anastomotic dehiscence was the indication for reoperation. In our experience, the mortality rate was 16.6% (3/18), in agreement with other reports in the literature. Analysis of risk factors in colorectal reoperation poses several methodological problems because we have no randomized multicentre studies that analyse risk factors in colorectal reoperation and the related surgical mortality.

Adolescent↗

PubMed2005

[Reoperations on lower urinary tract due to foreign body after urinary incontinence surgery].

OBJECTIVE: The usage of non-absorbable synthetic materials in female incontinence surgery could give rise to serious complications. The aim of this study was to describe results of reoperations due to foreign body near or within lower urinary tract in female patients previously undergoing stress incontinence surgery. MATERIAL AND METHODS: This was a retrospective study of patients referred to the author with miscellaneous symptoms after stress incontinence surgery. The reoperations were performed in the period March 1996 to May 2004. All patients were followed after reoperation. Results are given as median, minimum and maximum value. RESULTS: Ten patients with median age 59,5 (28-82) years were reoperated between half and 56 months from the primary operation. Urinary infection, pain, incontinence and various lower urinary tract symptoms were the most common symptoms. Nine patients were diagnosed by cystoscopy. Four had previously undergone tension-free vaginal tape surgery (TVT), four needle suspension surgery and two retropubic colposuspension. Seven were reoperated with open retropubic surgery, in two cases TVT was removed below urethra and non-absorbable suture was removed transvaginally in one patient. Foreign body was within the lower urinary tract in seven cases. In three cases, transurethral endoscopic removal of foreign body was performed without long-term success and further surgery needed. The overall results of the reoperations was very satisfying in terms of complete removal of foreign bodies and regress of symptoms. Convalescence was uneventful and only one patient got superficial skin infection. No other complications occurred. None has needed further reoperations in the follow-up period (6-78 months). CONCLUSIONS: Complications after usage of non-absorbable material in stress incontinence surgery could be serious and give chronic urinary symptoms. It is very important for the surgeon to be aware of this in all patients having unsuccessful recovery after incontinence surgery.

Adult↗

PubMed2005

[Diagnosis and reoperation for thyroid carcinoma].

OBJECTIVE: To analysis the reasons of the reoperation of thyroid neoplasm and the efficiency of the surgery and to explore the diagnosis of thyroid neoplasm in order to choose the rational surgical method. METHODS: Reoperation of thyroid cancers were performed in 128 patients from Oct. 1992 to Oct. 2000. The causes of reoperation were thyroid cancer remnants and persistence of the micro carcinoma The type of reoperation includes: 1. completion of lobectomy and isthmectomy or subtotal thyroidectomy. Radical neck dissection or modified neck dissection were indicated for the neck of lymph node metastasis. 2. completion of lobectomy and isthmectomy and modified neck dissection or selective neck dissection for patient with thyroid micro carcinoma. Preoperative fine needle aspiration (FNA) (10 cases), intra-operative frozen section (FS) (55 cases), FNA and FS (13 cases) were done in 78 patients who first visited our hospital, with pure (solitary) thyroid nodule suspected thyroid carcinoma clinically. The results of the above examinations were compared with postoperative pathological results. RESULTS: For the patients with reoperation, the rate of remained cancer was 68.8% (88/128) which was confirmed by pathological results. The occurring of complication was 23.4% (30/128). Laryngeal recurrent nerve paralysis was accounted for 2. 3% and transient postoperative hypocalcemia occurred in 19.5%. Five patients developed local recurrence and 3 had neck metastasis the following up. The 5-, 10-year survival rates of these patients were 92.0% (101/110) and 86.9% (17/20) respectively. The diagnostic accuracy of preoperative FNA, intra-operative FS, FNA and FS were 90.0%, 87.3% and 92.3% respectively. CONCLUSIONS: The rate of postoperative residual carcinoma in thyroid was relatively higher because of misdiagnosis and inadequate operation. It was necessary to take active and reasonable reoperation. Reoperation added to surgical complications. Increasing preoperative diagnostic accuracy & carrying out standard, adequate surgical treatment are the essence to decrease surgical complication.

Adolescent↗

PubMed2006

Reoperations for occluded arterial bypasses in the lower limbs.

BACKGROUND: We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. METHODS: The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions above the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. RESULTS: The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P < 0.05). Four patients died of heart attack (2), stroke (1) and multiple organ failure (1) after reoperations. Among them, only 1 patient underwent occluded bypass, and others, patent bypass. Five patients after patent bypass are still alive. The accumulative patent rate was 28.6% (8/28). The average duration of patency in groups T and C was (4.16 +/- 5.68) (0.13 - 24) months and (7.14 +/- 6.37) (0.26 - 21) months, respectively (P > 0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P < 0.01). Nine patients had limb amputated (10/28 limbs, 35.71%) because of graft infection (2 limbs), pseudo aneurysm at anastomosis (1 limb), and gangrene caused by failed grafts (7 limbs). The amputation was performed on 6 limbs within 1 month and on 4 limbs 1 month after reoperation (P > 0.05). The rate of limb salvage was 64.29% (18/28). CONCLUSIONS: The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.

Aged↗

PubMed1986

Reoperative achalasia surgery.

Forty-six patients with esophageal achalasia required reoperation between January 1970 and January 1986. Three of these patients required a second reoperative procedure, for a total of 49 reoperations. Indications for reoperation were inadequate myotomy, 17; gastroesophageal reflux, 14; concomitant antireflux operation, six; incorrect diagnosis, four; carcinoma of the esophagus, four; megaesophagus, three; and paraesophageal hernia, one. Various procedures were employed at the time of reoperation, including revision of the myotomy, takedown or revision of a previously performed wrap, fundoplication, and resection. Of the 48 patients available for follow-up study over an average postoperative period of 5 years, the condition of 38 (79%) was considered to have been improved by reoperation. The best results were obtained by revision or takedown of a previous wrap (an improvement rate of 88.9%) and radical resective procedures (89% to 100%). We conclude that for good results to be achieved after reoperative achalasia procedures, the preoperative diagnosis must be accurate, the operation should be performed early before the development of megaesophagus, and a short but complete esophagomyotomy must be performed, preferably without the addition of an antireflux procedure. Elimination or revision of a previously performed fundoplication can be expected to be followed by good results. The precise indications for radical resective procedures have yet to be defined clearly, but their wider application to carefully selected patients with postoperative achalasia seems justified.

Adult↗

PubMed1985

[Reoperation after saphenous aortocoronary bypass].

The results of a consecutive series of 24 patients reoperated for coronary bypass grafting between May 1977 and February 1983 are reported. The overall incidence of reoperation was 1.4 p. 100 (24 out of 1 716 cases); the incidence is tending to increase (2.3 p. 100 in 1982). Preoperative assessment revealed the persistence of cardiovascular risk factors: 75 p. 100 of patients had continued to smoke; 61 p. 100 had persistent hyperlipidaemia. The usual presenting syndrome was recurrence of chest pain (21 out of 24 cases) leading to control coronary arteriography on the results of which the surgical indication was based. The average time between the two operations was 38.7 months. The patients were classified into two groups; early reoperation (6 cases) for a technical problem or incomplete revascularisation, and late reoperation (8 cases) for disease of the graft and atherosclerosis. Progression of coronary atherosclerosis was the major long-term cause of occlusion of the saphenous graft (10-14 cases). The arteries most commonly bypassed at reoperation were the left anterior descending and right coronary arteries (12 times each). Reoperation comprised single bypass (13 cases), double bypass (10 cases) and triple bypass (1 case) with an average of 1.5 grafts per patient. The most commonly used vein was the internal saphenous vein (32 out of 36 grafts). Myocardial protection was insured by cardioplegia (13 cases) and intermittent clamping (10 cases) after cooling (general hypothermia at 22 degrees C). Global reoperative mortality (4 p. 100) was higher than for elective primary coronary surgery (2.3 p. 100). The incidence of perioperative infarction was 8 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗

PubMed1985

Reoperation for postoperative haemorrhagic complications. Analysis of a 10-year series.

All 527 postoperative haemorrhagic complications requiring reoperation from 1971 through 1980 were retrospectively analyzed. These operations constituted 1.2% of the total performed. Gastric resection, mastectomy and thyroid/parathyroid surgery showed significantly higher than average incidence of bleeding complications. No previously unknown cases of bleeding diathesis were detected. Drain was used in 34.5% of the primary operations, but rarely contributed to diagnosis of bleeding and did not reduce delay before reoperation. Shock or preshock was present in 15% of the patients. No source of haemorrhage was detected at 14% of the reoperations. Complications of various types were associated with 13% of the reoperations, with rebleeding and infectious conditions predominant. Complications of reoperation significantly prolonged the hospital stay, but did not raise the mortality rate. Mortality, however, was significantly higher after the reoperations than after the total primary operations during the study period (5.3 vs. 2.7%). Patients who had undergone arterial surgery were analyzed in more detail. There were 1.6% reoperations in this group. The bleeding emanated from anastomosis or arterial suture in only half of these cases and was then of two types--early, from technical causes or delayed, caused by infection.

Adolescent↗

PubMed1985

Results of reoperation for primary tissue failure of porcine bioprostheses.

Results of reoperation for primary tissue failure of porcine bioprostheses were evaluated in 574 patients discharged from the hospital from 1970 to 1981. A total of 413 had undergone isolated mitral valve replacement and 161 isolated aortic valve replacement. Through March, 1984, 88 patients (15%) had required reoperation: 59 had undergone mitral and 29, aortic valve replacement. Primary tissue failure was the main cause of bioprosthetic dysfunction; it occurred in 64 patients (46 mitral and 18 aortic) at a mean postoperative interval of 93 +/- 4 months (range 34 to 158). During the same period, 11 patients required reoperation for bioprosthetic endocarditis, 11 for paravalvular leak, and two for thrombosis. These patients are not included in this review. Reoperation for primary tissue failure was performed after a mean interval of 72 +/- 6 months (range 38 to 158) for patients with aortic bioprostheses and after 101 +/- 5 months (range 34 to 153) for those with mitral bioprostheses (p less than 0.05). Overall mortality at reoperation was 12.5%: 11% for the mitral group and 16% for the aortic group. In 62 patients (45 mitral and 17 aortic) primary tissue failure was caused by calcification of the cusps, associated with severe fibrous tissue overgrowth in seven. Bioprosthetic failure was caused by an intracuspal hematoma in one patient with mitral valve replacement and by lipid infiltration of the cusps in one patient with aortic valve replacement. Actuarial freedom from bioprosthetic primary tissue failure at 12 years is 61% +/- 5% for the mitral group and 69% +/- 7% for the aortic group. On the basis of our long-term follow-up of patients after mitral or aortic replacement with a porcine bioprosthesis, we conclude: primary tissue failure is the most frequent indication for reoperation in patients with a porcine bioprosthesis; calcification of the cusp tissue is the leading cause of primary tissue failure; reoperation for primary tissue failure may be a major concern, although mortality for elective cases is low; and the limited durability of porcine bioprostheses suggests their use be restricted to selected patients.

Animals↗