Wataru Tatsuishi1,2, Hiraku Kumamaru3, Tomonobu Abe4, Kiyoharu Nakano5, Hiroaki Miyata3, Noboru Motomura5. 1. Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Showa-machi 3-39-22, Maebashi, Gunma, Japan. wataru0812_drt@yahoo.co.jp. 2. Japan Cardiovascular Surgery Database Organization, Tokyo, Japan. wataru0812_drt@yahoo.co.jp. 3. Department of Healthcare Quality Assessment, University of Tokyo Graduate School of Medicine, Tokyo, Japan. 4. Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Showa-machi 3-39-22, Maebashi, Gunma, Japan. 5. Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
Abstract
OBJECTIVE: This study compared operative mortality and morbidity based on the number of previous cardiac operations to identify whether this was a risk factor for outcomes after valve reoperation. METHODS: Among valve surgery patients in the Japan Cardiovascular Surgery Database (2013‒2015), 4436 patients who underwent valve reoperation with a previous cardiac surgery were included. Patients were divided into three groups based on the number of previous cardiac operations (NPO1, NPO2, and NPO3+). Multivariable logistic regression analyses were conducted, adjusting for patient- and surgery-related factors to estimate the association of the NPO with the clinical outcomes of valve reoperation. RESULTS: Postoperative mortality was 8.6% in the NPO1, 11.2% in the NPO2, and 14.4% in the NPO3 + group, and the corresponding postoperative morbidity rates were 40.0, 46.2, and 59.2%, respectively. On multivariable logistic regression analysis, the odds of operative death were 1.36 (95% confidence interval [CI] 0.98‒1.87, p = 0.06) times higher for the NPO2 and 1.61 (95% CI 0.89‒2.90, p = 0.11) times higher for the NPO3+ group than for the NPO1 group. The odds ratios for postoperative complications were 1.31 (95% CI 1.08‒1.59, p < 0.01) for the NPO2 and 2.49 (95% CI 1.66‒3.74, p < 0.01) for the NPO3+ relative to the NPO1 group. CONCLUSION: The number of previous cardiac operations is associated with postoperative outcomes in patients undergoing valve reoperations. Considering the risk of repeat cardiac surgery, we recommend careful selection of operative procedures to avoid reoperation in patients requiring primary valve surgery.
OBJECTIVE: This study compared operative mortality and morbidity based on the number of previous cardiac operations to identify whether this was a risk factor for outcomes after valve reoperation. METHODS: Among valve surgery patients in the Japan Cardiovascular Surgery Database (2013‒2015), 4436 patients who underwent valve reoperation with a previous cardiac surgery were included. Patients were divided into three groups based on the number of previous cardiac operations (NPO1, NPO2, and NPO3+). Multivariable logistic regression analyses were conducted, adjusting for patient- and surgery-related factors to estimate the association of the NPO with the clinical outcomes of valve reoperation. RESULTS: Postoperative mortality was 8.6% in the NPO1, 11.2% in the NPO2, and 14.4% in the NPO3 + group, and the corresponding postoperative morbidity rates were 40.0, 46.2, and 59.2%, respectively. On multivariable logistic regression analysis, the odds of operative death were 1.36 (95% confidence interval [CI] 0.98‒1.87, p = 0.06) times higher for the NPO2 and 1.61 (95% CI 0.89‒2.90, p = 0.11) times higher for the NPO3+ group than for the NPO1 group. The odds ratios for postoperative complications were 1.31 (95% CI 1.08‒1.59, p < 0.01) for the NPO2 and 2.49 (95% CI 1.66‒3.74, p < 0.01) for the NPO3+ relative to the NPO1 group. CONCLUSION: The number of previous cardiac operations is associated with postoperative outcomes in patients undergoing valve reoperations. Considering the risk of repeat cardiac surgery, we recommend careful selection of operative procedures to avoid reoperation in patients requiring primary valve surgery.
Authors: Sean M O'Brien; Liqi Feng; Xia He; Ying Xian; Jeffrey P Jacobs; Vinay Badhwar; Paul A Kurlansky; Anthony P Furnary; Joseph C Cleveland; Kevin W Lobdell; Christina Vassileva; Moritz C Wyler von Ballmoos; Vinod H Thourani; J Scott Rankin; James R Edgerton; Richard S D'Agostino; Nimesh D Desai; Fred H Edwards; David M Shahian Journal: Ann Thorac Surg Date: 2018-03-22 Impact factor: 4.330