Modern practice and outcomes of reoperative cardiac surgery

Patients who underwent reoperative sternotomy were grouped into peripheral cardiopulmonary bypass (CPB) before redo sternotomy (early) and those placed on CPB after redo sternotomy (late). Further categories were based on high or low anatomic risk as revealed by computed tomography imaging. Patients with hemodynamic instability who quickly required unplanned early cardiopulmonary bypass were excluded from comparative effectiveness comparisons. The bottom portion of the illustration shows computed tomography features favoring use of each approach—early versus late institution of CPB. Overall operative mortality for reoperative cardiac surgery is low at an experienced center with comparable outcomes across early or late CPB strategies. Optimal outcomes with reoperative cardiac surgery require continuous team-based practice and preparedness, use of advanced imaging, implementation of technological adjuncts, and a multidisciplinary effort.