Evolution of redo cardiac surgery: review of personal experience.

This presentation summarizes the author's personal observations on the major advances in reoperative cardiac surgery. They include earlier referral for cardiac prosthetic and bioprosthetic cardiac valve dysfunction, alternative incisional approaches to minimize injury to adherent cardiac structures, alternative perfusion sites, improved hemostasis on cardiopulmonary bypass, improved myocardial protection, tailoring the valve prosthesis to the patients' anatomy and clinical situation, "no-touch" technique in reoperative coronary artery surgery, and increasing use of hypothermic circulatory arrest for recurrent ascending arch and descending thoracic pathology. Each of these is explained in detail with the appropriate references and retrospective data collections where appropriate. This risk of reoperative cardiac surgery will continue to improve as these and additional techniques continue to evolve and become simplified. Further investigation into the clinical uses of minimally invasive techniques including robot technology, may eventually reduce morbidity and mortality of reoperations to that equal to primary operations.