Surgical management of atrial fibrillation in redo cardiac operations

With improving surgical care yielding better outcomes, patients who have undergone a cardiac operation are surviving longer, and surgeons will inevitably face an increasing number of reoperative procedures whether it is for surgical ablation of atrial fibrillation (AF) or other cardiac pathology. General approaches to reoperation and resternotomy are covered in other sections, but it is worth emphasizing that approximately 10% of all adult cardiac operations involve a redo sternotomy, which carries an 8% risk of significant hemorrhage (J Am Coll Surg 206: 993-9, 2008). Thus, it is important to weigh the potential risks and benefits of additional procedures, such as ablation of AF, in these patients who have higher than normal morbidity and mortality.