Obesity and long-term prognosis in heart failure: the paradox persists.

of the surgical technique due to the absence of pericardial closure after initial heart surgery and the development of adhesions. Reoperation status remained an independent predictor of operative death after adjusting for confounding factors. The aorta, right ventricle, and bypass grafts may adhere to the underside of the sternum and can be easily injured at reoperation. In-hospital mortality for patients undergoing cardiac reoperation is higher than that of patients undergoing primary surgical intervention4,5. Previous surgical revascularization is a predictive factor for early mortality.6 One of the methods thought to reduce the morbidity and mortality associated with reoperation is the use of pericardial substitutes, serving to conserve the anatomical relationship. The heterogeneity of available materials, both synthetic and biological, is an indicator of the fact that an ideal tissue substitute has yet to be identified. In conclusion the findings from the patient presented here with the results from a shortterm study suggest that the biodegradable collagen-elastin membrane constitutes a safe, effective option for pericardial closure. At reoperation, the use of this membrane appears to reduce the risk of structural damage during dissection while also reducing surgery time and morbidity/mortality.