Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation: What is the operative risk?

Sebastian A. Iturra, Kevin L. Greason, Rakesh M. Suri, Lyle D. Joyce, John M. Stulak, Alberto Pochettino, Hartzell V Schaff

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Conclusions Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.

Methods We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7 ± 3.2 years, male sex in 322 patients (51.2%), and Society of Thoracic Surgeons predicted risk of mortality of 6.2% ± 4.4%. Operations included a primary sternotomy in 518 patients (82.4%) and a repeat sternotomy in 111 patients (17.6%) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study.

Objectives There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation.

Results Cardiopulmonary bypass time was longer with repeat sternotomy (88.0 ± 45.7 minutes) in comparison to primary sternotomy (66.5 ± 25.1; P <.001); but there was no difference in the aortic crossclamp time (51.1 ± 19.7 minutes vs 49.2 ± 17.7 minutes; P =.282). Stroke occurred in 3 patients (2.7%) following repeat sternotomy and in 10 (1.9%) after primary sternotomy (P =.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4%) after repeat sternotomy and in 19 patients (3.7%) following primary sternotomy (P =.196). Repeat sternotomy was not predictive of operative mortality.

Original languageEnglish (US)
Pages (from-to)1899-1902
Number of pages4
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number5
DOIs
StatePublished - Nov 1 2014

Fingerprint

Sternotomy
Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Coronary Artery Bypass
Transplants
Mortality
Cardiopulmonary Bypass
Reoperation
Renal Insufficiency
Stroke
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation : What is the operative risk? / Iturra, Sebastian A.; Greason, Kevin L.; Suri, Rakesh M.; Joyce, Lyle D.; Stulak, John M.; Pochettino, Alberto; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 5, 01.11.2014, p. 1899-1902.

Research output: Contribution to journalArticle

@article{6fbfdc90c9da4f1a80a103cb06d7ce5a,
title = "Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation: What is the operative risk?",
abstract = "Conclusions Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.Methods We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7 ± 3.2 years, male sex in 322 patients (51.2{\%}), and Society of Thoracic Surgeons predicted risk of mortality of 6.2{\%} ± 4.4{\%}. Operations included a primary sternotomy in 518 patients (82.4{\%}) and a repeat sternotomy in 111 patients (17.6{\%}) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study.Objectives There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation.Results Cardiopulmonary bypass time was longer with repeat sternotomy (88.0 ± 45.7 minutes) in comparison to primary sternotomy (66.5 ± 25.1; P <.001); but there was no difference in the aortic crossclamp time (51.1 ± 19.7 minutes vs 49.2 ± 17.7 minutes; P =.282). Stroke occurred in 3 patients (2.7{\%}) following repeat sternotomy and in 10 (1.9{\%}) after primary sternotomy (P =.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4{\%}) after repeat sternotomy and in 19 patients (3.7{\%}) following primary sternotomy (P =.196). Repeat sternotomy was not predictive of operative mortality.",
author = "Iturra, {Sebastian A.} and Greason, {Kevin L.} and Suri, {Rakesh M.} and Joyce, {Lyle D.} and Stulak, {John M.} and Alberto Pochettino and Schaff, {Hartzell V}",
year = "2014",
month = "11",
day = "1",
doi = "10.1016/j.jtcvs.2013.11.048",
language = "English (US)",
volume = "148",
pages = "1899--1902",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation

T2 - What is the operative risk?

AU - Iturra, Sebastian A.

AU - Greason, Kevin L.

AU - Suri, Rakesh M.

AU - Joyce, Lyle D.

AU - Stulak, John M.

AU - Pochettino, Alberto

AU - Schaff, Hartzell V

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Conclusions Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.Methods We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7 ± 3.2 years, male sex in 322 patients (51.2%), and Society of Thoracic Surgeons predicted risk of mortality of 6.2% ± 4.4%. Operations included a primary sternotomy in 518 patients (82.4%) and a repeat sternotomy in 111 patients (17.6%) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study.Objectives There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation.Results Cardiopulmonary bypass time was longer with repeat sternotomy (88.0 ± 45.7 minutes) in comparison to primary sternotomy (66.5 ± 25.1; P <.001); but there was no difference in the aortic crossclamp time (51.1 ± 19.7 minutes vs 49.2 ± 17.7 minutes; P =.282). Stroke occurred in 3 patients (2.7%) following repeat sternotomy and in 10 (1.9%) after primary sternotomy (P =.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4%) after repeat sternotomy and in 19 patients (3.7%) following primary sternotomy (P =.196). Repeat sternotomy was not predictive of operative mortality.

AB - Conclusions Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.Methods We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7 ± 3.2 years, male sex in 322 patients (51.2%), and Society of Thoracic Surgeons predicted risk of mortality of 6.2% ± 4.4%. Operations included a primary sternotomy in 518 patients (82.4%) and a repeat sternotomy in 111 patients (17.6%) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study.Objectives There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation.Results Cardiopulmonary bypass time was longer with repeat sternotomy (88.0 ± 45.7 minutes) in comparison to primary sternotomy (66.5 ± 25.1; P <.001); but there was no difference in the aortic crossclamp time (51.1 ± 19.7 minutes vs 49.2 ± 17.7 minutes; P =.282). Stroke occurred in 3 patients (2.7%) following repeat sternotomy and in 10 (1.9%) after primary sternotomy (P =.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4%) after repeat sternotomy and in 19 patients (3.7%) following primary sternotomy (P =.196). Repeat sternotomy was not predictive of operative mortality.

UR - http://www.scopus.com/inward/record.url?scp=84911007334&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911007334&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2013.11.048

DO - 10.1016/j.jtcvs.2013.11.048

M3 - Article

C2 - 24507401

AN - SCOPUS:84911007334

VL - 148

SP - 1899

EP - 1902

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 5

ER -