Redo cardiac surgery in the era of percutaneous solutions: pattern of presentation and outcomes in a single tertiary care center

Abstract Introduction The advent of new medical and interventional approaches has recently impacted on the referral for redo surgical operations. Little is known current practice pattern outcomes. Purpose We reviewed our institutional experience 10 years (January 2011–December 2020) in a single university affiliated center to document frequency, outcome, complications various types procedures. Methods Retrospective analysis prospectively collected computed database developed according STS/EACTS recommendations. Results During study period 616 patients were referred cardiac procedures, which 129 underwent either or procedures (75 thrombolysis, 22 valve-in-valve, 19 native mitral tricuspid percutaneous treatment, 13 paravalvular leakage devices), 459 operated on, 28 denied any invasive treatment because futility. Study group included these with mean age 62±12.7 (octogenarians 5.6%, female sex 52.8%, diabetes 19.5%, chronic kidney disease 30%, urgent/emergent status 34.8%, third-time sternotomy 9.8%). EuroSCORE II averaged 25.7±15.4%. represented nearly constant subgroup over 6890 this decade. Most frequent valve operations, accomplished 48.6% (223 pts), whereas isolated coronary bypass surgery was performed 1.9% (9 pts) only. Valve thrombosis, mechanical prosthesis malfunction, leakage, bioprosthetic failure endocarditis (87% prosthetic valve) most indications. Combined 15.2% (70 pts). Aortic root, ascending arch replacement 10.9% (50 pts, aortic dissection 7.8%). Cardiac transplantation setting previous 13.1% (60 pts including: conventional [29 pts], circulatory devices [28 25 left ventricular assist device 3 total artificial heart] re-transplantation [3 pts]). Other 10.2% (47 Overall hospital mortality 23,9%, rates major were: revision bleeding 2,9%, Acute Kidney Injury (I/F) 17,4%, prolonged ventilation 12,9%, stroke 2,7%. Age, priority, endocarditis, heart independent predictors morbidity mortality. Conclusions Although solutions are increasing their consensus, rate remained stable during last years. Outcomes satisfactory despite increasingly complex features. Careful Heart Team evaluation mandatory. Funding Acknowledgement Type funding sources: None.