Redo Cardiac Surgery in Adults

202 Pages·2012·5.53 MB·English

by  Hartzell V. Schaff

Redo Cardiac Surgery in Adults
Venkat R. Machiraju (cid:129) Hartzell V. Schaff
Lars G. Svensson
Editors
Redo Cardiac Surgery
in Adults
Second Edition
Editors
Venkat R. Machiraju Hartzell V. Schaff
Department of Cardiothoracic Surgery Division of Cardiovascular Surgery
University of Pittsburgh Medical Center Mayo Clinic
Pittsburgh, PA, USA Rochester, MN, USA
[email protected] [email protected]
Lars G. Svensson
Department of Thoracic
and Cardiovascular Surgery
Cleveland Clinic Foundation
Cleveland, OH, USA
[email protected]
ISBN 978-1-4614-1325-7 e-ISBN 978-1-4614-1326-4
DOI 10.1007/978-1-4614-1326-4
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011940808
© Springer Science+Business Media, LLC 2012
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Preface to the Second Edition
The fi rst edition of Redo Cardiac Surgery in Adults was published in 1996 and
was a compilation of the proceedings of the First International Symposium on
Redo Cardiac Surgery. During the last 16 years, several changes have occurred,
not only in the profi les of the patients requiring redo cardiac surgery, but also
in the redo cardiac surgical procedures that are performed. Overall, while the
experience of cardiac surgeons has increased, the complexity of the surgical
procedures and the comorbid conditions of the patients have also increased.
Twenty years ago, redo coronary artery bypass surgery was the most common
redo cardiac surgery performed in the adult population. Now, isolated redo
coronary artery bypass surgery is virtually gone, and more complex redo val-
vular surgical procedures along with aortic arch and thoracic aortic procedures
are performed routinely. These procedures in turn lead to newer redo cardiac
surgical procedures. As younger cardiac surgeons enter the fi eld of cardiac
surgery, it will be diffi cult for them to gain extensive experience in all the redo
cardiac surgical procedures during the short period of their training. While
experienced surgeons have fi gured out for themselves how to handle various
diffi cult situations, younger surgeons are always looking for some guidance.
There have been several improvements over the years in the management of
perioperative complications. Perioperative stroke is addressed quickly with
various interventional procedures to limit or obviate any neurological defi cit.
Similarly, renal failure is managed with early dialysis to prevent mortality and
improve survival. The purpose of this book is to give some practical sugges-
tions to surgeons rather than to provide lot of theoretical data to the reader.
The book is divided into a Coronary and General section, which includes
coronary artery revascularization procedures and management of the com-
mon major perioperative complications, and Mitral and Aortic sections. The
authors who contributed the chapters are actively practicing their subspecialty
and, as such, they present the current standard of care in managing various
surgical problems. Though we cannot discuss rare redo cardiac surgical prob-
lems, this book focuses on day-to-day surgical problems that arise during the
redo cardiac surgery.
We express our special thanks to Shannon Wyszomierski, Ph.D. for her
assistance with the editorial work.
Pittsburgh, PA, USA Venkat R. Machiraju, MD
Rochester, MN, USA Hartzell V. Schaff, MD
Cleveland, OH, USA Lars G. Svensson, MD
v
Contents
1 Problems Related to Redo Cardiac Surgery .............................. 1
Venkat R. Machiraju
2 Practical Approaches to the Current “On-Pump”
Redo Coronary Artery Bypass Surgery ..................................... 7
Venkat R. Machiraju
3 Off-Pump Coronary Artery Bypass Grafting for Repeat
Coronary Revascularization ....................................................... 21
Richard J. Myung and John D. Puskas
4 Management of Perioperative Stroke ......................................... 29
Amer M. Malik and Lawrence R. Wechsler
5 Acute Kidney Injury Associated with Cardiac Surgery ........... 37
Mitchell H. Rosner
6 Pulmonary Factors in Redo Open Heart Surgery .................... 53
David O. Wilson
7 Transfusion Therapy in Reoperative Cardiac Surgery ............ 57
Anand Padmanabhan and Darrell J. Triulzi
8 Anesthesia for Redo Cardiac Surgery ........................................ 63
Cynthia M. Wells and Andrew W. Murray
9 Options for Advanced Mechanical Support for Cardiogenic
Shock Complicating Cardiac Reoperations ............................... 67
Christian Bermudez, Kenji Minakata, and Robert L. Kormos
10 Reoperations for Mitral Valve Disease: Surgical
Approaches and Techniques ........................................................ 81
Hartzell V. Schaff and Arman Arghami
11 Reoperation Following Mitral Valve Repair ............................. 89
Rakesh M. Suri and Hartzell V. Schaff
12 Reoperation for Prosthetic Mitral Valve Endocarditis ............. 99
Kevin L. Greason and Hartzell V. Schaff
13 Surgical Management of Atrial Fibrillation in Redo
Cardiac Operations ...................................................................... 109
John M. Stulak and Hartzell V. Schaff
vii
viii Contents
14 Surgical Management of Tricuspid Valve Disorders ................ 121
Venkat R. Machiraju
15 Reoperation for Aortic Valve Disease......................................... 125
Lars G. Svensson
16 Reoperation Following Homograft Aortic Valve
Replacement ................................................................................. 133
Thoralf M. Sundt III
17 Prosthetic Aortic Valve and Root Endocarditis ........................ 141
Gosta B. Pettersson, Rajesh Ramankutty, Brian Griffi n,
and Thomas Fraser
18 Reoperation on the Aortic Arch ................................................. 151
Lars G. Svensson
19 Descending and Thoracoabdominal Aortic Reoperations ....... 157
Edward Soltesz
20 Reoperations Following Endovascular Aortic Repair .............. 171
Eric E. Roselli
21 Percutaneous Approaches to Valvular Heart Disease
After Previous Cardiac Surgery ................................................. 195
John M. Stulak and Hartzell V. Schaff
Index ...................................................................................................... 201
Contributors
Arman Arghami , MD Division of Cardiovascular Surgery , Mayo Clinic ,
Rochester , MN , USA
Christian Bermudez , MD Department of Cardiothoracic Surgery ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
Thomas Fraser , MD Division of Cardiac Infections,
Department of Infectious Diseases , Cleveland Clinic , Cleveland , OH , USA
Kevin L. Greason , MD Division of Cardiovascular Surgery , Mayo Clinic ,
Rochester , MN , USA
Brian Griffi n , MD Department of Cardiovascular Medicine ,
Cleveland Clinic , Cleveland , OH , USA
Robert L. Kormos , MD Department of Cardiothoracic Surgery ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
Venkat R. Machiraju , MD Department of Cardiothoracic Surgery ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
Amer M. Malik , MD Department of Neurology, UPMC Stroke Institute ,
University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
Kenji Minakata , MD Department of Cardiothoracic Surgery ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
Andrew W. Murray , MBChB Department of Anesthesiology ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
Richard J. Myung , MD Emory University, Wellstar Kennestone Hospital ,
Marietta , GA , USA
Anand Padmanabhan , MD Department of Pathology,
Division of Transfusion Medicine , University of Pittsburgh School
of Medicine , Pittsburgh , PA , USA
Gosta B. Pettersson , MD Department of Thoracic and Cardiovascular
Surgery , Surgical Director of Lung Transplant Unit, Cleveland Clinic ,
Cleveland , OH , USA
John D. Puskas , MD Division of Cardiothoracic Surgery ,
Emory University School of Medicine , Atlanta , GA , USA
ix
x Contributors
Rajesh Ramankutty , MD Department of Thoracic and Cardiovascular
Surgery , Surgical Director of Lung Transplant Unit, Cleveland Clinic ,
Cleveland , OH , USA
Eric E. Roselli , MD Department of Thoracic and Cardiovascular Surgery ,
Cleveland Clinic , Cleveland , OH , USA
Mitchell H. Rosner , MD Division of Nephrology , University of Virginia
Health System , Charlottesville , VA , USA
Hartzell V. Schaff , MD Division of Cardiovascular Surgery ,
Mayo Clinic , Rochester , MN , USA
Edward Soltesz , MD, MPH Department of Thoracic and Cardiovascular
Surgery , Cleveland Clinic , Cleveland , OH , USA
John M. Stulak , MD Division of Cardiovascular Surgery ,
Mayo Clinic , Rochester , MN , USA
Thoralf M. Sundt III, MD Massachusetts General Hospital ,
Boston , MA , USA
Rakesh M. Suri , MD, DPhil Division of Cardiovascular Surgery ,
Mayo Clinic , Rochester , MN , USA
Lars G. Svensson , MD, PhD Department of Thoracic
and Cardiovascular Surgery , Cleveland Clinic Foundation ,
Cleveland , OH , USA
Darrell J. Triulzi , MD Department of Pathology, Division of Transfusion
Medicine, University of Pittsburgh School of Medicine , Pittsburgh ,
PA , USA
Lawrence R. Wechsler , MD Department of Neurology ,
University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
Cynthia M. Wells , MD Department of Anesthesiology ,
University of Pittsburgh Medical Center , Pittsburgh , PA , USA
David O. Wilson , MD, MPH Division of Pulmonary,
Allergy and Critical Care Medicine , University of Pittsburgh
Medical Center , Pittsburgh , PA , USA
1
Problems Related to Redo
Cardiac Surgery
Venkat R. Machiraju
ditions of the patient and the type of operation but
Introduction
also to the number of previous operations. While
fi rst-time redo cardiac surgical procedures have
Redo cardiac surgery has several inherent chal-
an increased risk of mortality for valve-related
lenges that can increase mortality and also mor-
procedures, generally redo cardiac procedures for
bidity to the patient. This chapter will discuss
coronary artery revascularization alone have been
several of the problems associated with technical
within an acceptable range (3.9%). Second-time
aspects of redo cardiac surgical procedures.
redo cardiac surgical procedures, even for coro-
Some aspects will be covered in more depth by
nary artery revascularization, have a notably
other authors in subsequent chapters.
increased risk of morbidity and mortality.
As is true for primary procedures, there are
At the beginning of a redo cardiac surgical
several important patient-related factors that con-
procedure, the surgeon can assess the overall
tribute to the risk of operative mortality of redo
potential for morbidity and mortality and give a
operations. Older age (>70 years), female sex,
good understanding to the patient and his or her
diabetes mellitus, chronic obstructive pulmonary
family of potential complications as well as the
emphysema, renal failure or elevated baseline
likelihood of survival. Preoperative insertion of
serum creatinine (>2 mg/100 mL), history of
an intra-aortic balloon for hemodynamic stability
stroke, and elevated total body weight are consid-
or acute myocardial infarction with either right or
ered as contributing factors for increased risk of
left ventricular failure from coronary artery
mortality during redo cardiac surgery. Additionally,
occlusion will increase the likelihood of morbid-
repeat valvular surgery for prosthetic valve endo-
ity and mortality. Similarly, patients in cardio-
carditis, a low starting left ventricular ejection
genic shock have a higher surgical risk. It is clear
fraction (~20%), and urgent operation indepen-
that the preoperative comorbid conditions and the
dently contribute to a higher mortality [ 1 ] . Heavy
urgency of the need for a surgical procedure dic-
mitral annular and aortic root calcifi cation in
tate the fi nal outcome. In addition, age greater
elderly makes valvular operation signifi cantly
than 80 years is correlated with decreased cogni-
more diffi cult and challenging. Indeed, the risk of
tive function in the postoperative period, which
operation is related not only to the comorbid con-
can lead to somnolence and other perioperative
complications, such as aspiration pneumonia and
gastrointestinal motility disorders. In the end,
V. R. Machiraju, MD ((cid:2)) resource utilization becomes important and,
Department of Cardiothoracic Surgery ,
fi nally, the patient may be transferred to an
University of Pittsburgh Medical Center ,
extended care facility with a tracheostomy, a per-
Pittsburgh , PA , USA
e-mail: [email protected] cutaneous endoscopic gastrostomy (PEG) tube,
V.R. Machiraju et al. (eds.), Redo Cardiac Surgery in Adults, 1
DOI 10.1007/978-1-4614-1326-4_1, © Springer Science+Business Media, LLC 2012