Reoperations for pediatric and congenital heart disease: an analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database

Abstract

In this descriptive analysis, data in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database pertaining to patients who underwent reoperative cardiac surgery were analyzed. Practice patterns and outcomes are described. Reoperative cardiac surgery for congenital heart disease is common, with one third of index operations in the database occurring subsequent to prior cardiothoracic operation(s) performed on cardiopulmonary bypass. This analysis suggests that a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, but that patients with greater number of previous operations appear to be at higher risk.

Figure 1

Discharge mortality stratified by number of prior CPB cardiothoracic operations. Discharge mortality in patients with 0, 1, 2, 3, 4, 5, and 6 or more prior cardiopulmonary bypass operations was 3.98%, 2.38%, 1.67%, 2.41%, 3.31%, 4.08%, and 5.07%, respectively.

Figure 2

Mean postoperative length of stay stratified by number of prior CPB cardiothoracic operations.

Figure 3

Single institutional data from the Mayo clinic which documents that increased early mortality after reoperation is associated with an increase in number of reoperative sternotomies.

Figure 4

Use of the anterior sternal retraction of the lower sternum with the Rultract retractor at the time of re-entrant median sternotomy.

Figure 5

Use of the anterior sternal retraction of the lower sternum with the Rultract retractor at the time of re-entrant median sternotomy, demonstrating how the heart can be separated from the sternum under direct vision.