H. Calvelli2, M. A. Kashem1, R. Raman1, H. Kehara1, K. Hanna2, K. Cheng3, M. Azuma2, R. May2, Y. Toyoda1 1Temple University Hospital, Department Of Cardiothoracic Surgery, Philadelphia, PA, USA 2Temple University, Lewis Katz School Of Medicine, Philadelphia, PA, USA 3Temple University, Center For Biostatistics And Epidemiology, Philadelphia, PA, USA
Introduction: Improvements in surgical techniques and perioperative care as well as increased patient life expectancies have led cardiothoracic surgeons to perform more complex operations, including reoperative open-heart surgery. Reoperative open-heart surgery has been associated with increased risk of mortality, and there is debate among surgeons as to which patients are acceptable operative candidates. We investigated variables associated with mortality in patients who underwent multiple open-heart surgeries.
Methods: We performed a retrospective study of patients who underwent reoperative cardiac surgery at our center from 2012–2022. Our study included patients ≥18 years old who had previous open-heart surgery. Patients who received previous ventricular assist device or heart transplant were excluded. Patients were stratified by age <65 versus age ≥65. Survival was assessed using Kaplan-Meier curves and log-rank tests, according to the following variables: age <65 versus ≥65, type of procedure (CABG versus valve surgery), and number of reoperation (1, 2, 3, or 4+). Cox proportional hazards regression was performed for propensity score matched groups using the same variables. P-values <0.05 were considered significant.? ?
Results: Among the 250 patients who underwent reoperative cardiac surgery from 2012-2022, 74/250 (29.6%) patients received a CABG, 176/250 (70.4%) received a valve repair/replacement, 31/250 (12.4%) received aortic surgery, and 31/250 (12.4%) received other operations. The overall mortality rate for our cohort was 34/250 (13.6%) at 30 days postoperatively and 53/250 (21.2%) at 1 year postoperatively. Patients ≥65 years old had higher survival compared to patients <65 years old (mean 5.0 years versus 4.1 years, P=0.046). However, there were no differences in survival based on age when patients were stratified by procedure, either CABG (P=0.295) or valve surgery (P=0.160). Survival was significantly associated with the number of reoperative open-heart surgeries, where patients with 1 reoperation had a 1-year mortality rate of 37/212 (17.5%) compared to 16/38 (42.1%) among patients with >1 reoperation. The Cox regression model showed that current or previous valve surgeries, ECMO requirement, and 4+ reoperative surgeries were also associated with lower survival.
Conclusion: Our findings demonstrated that older patients had higher survival compared to younger patients after reoperative open-heart surgery, suggesting that procedure type played a significant role, as older patients were more likely to undergo reoperation for lower-risk procedures, such as CABG and valve surgeries. The number of reoperations was significantly associated with survival, as patients requiring only 1 reoperation had higher survival.