One Thousand Repeat Sternotomies for Congenital Cardiac Surgery: Risk Factors for Reentry Injury

• Published in: The Annals of thoracic surgery Vol. 88; no. 1; pp. 158 - 161
• Main Authors: Kirshbom, Paul M., MD, Myung, Richard J., MD, Simsic, Janet M., MD, Kramer, Zachary B., BS, Leong, Traci, PhD, Kogon, Brian E., MD, Kanter, Kirk R., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2009; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Child; Child, Preschool; Female; Follow-Up Studies; Heart; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Hospital Mortality; Humans; Infant; Infant, Newborn; Intraoperative Complications - mortality; Male; Medical sciences; Pneumology; Postoperative Complications - mortality; Probability; Registries; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Sex Factors; Sternum - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Thoracotomy - adverse effects; Thoracotomy - methods; Time Factors; Young Adult; 18; Sternotomy; Arrhythmia; Congenital; Reentry; Injury; Cardiovascular disease; Cardiac surgery; Excitability disorder; Heart disease; Risk factor; Cardiovascular risk; Anesthesia; Circulatory system; Lesion; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.03.082

Background Reentry injury is a risk associated with repeat sternotomy for cardiac surgery. This risk has been well defined for adults, but there is less information available for patients with congenital heart disease. The goal of this review was to identify the incidence, risk factors, and outcomes for reentry injury in patients with congenital heart disease. Methods Eight hundred two patients with congenital heart disease had 1,000 consecutive repeat sternotomies between August 2000 and November 2007. Records were reviewed for demographics, history, operative techniques, and outcomes. Univariate risk factors for reentry injury and operative mortality were assessed. Results Median age and weight were 2.1 years (range, 0.1 to 34.6 years) and 11 kg (range, 2.5 to 123 kg). There were 639 second, 287 third, and 74 fourth or higher sternotomies. There were 13 reentry injuries (1.3%) involving right ventricle–pulmonary artery conduits (n = 4), aorta or aortic conduits (n = 3), right ventricular outflow tract patches or pseudoaneurysms (n = 3), and others (n = 3). Risk factors for injury were presence of a right ventricle–pulmonary artery conduit (6 of 115 with conduit [5.2%] versus 7 of 885 without [0.8%]; p < 0.001) and sternotomy number (relative risk, 2.28; p < 0.001). Reentry injury was associated with longer procedure times (median, 420 minutes with injury versus 248 without; p < 0.001). Operative mortality occurred in 18 patients and was associated with sternotomy number and procedure time ( p < 0.001), but not reentry injury ( p = 0.2). Conclusions Risk of reentry injury during repeat sternotomy for congenital heart disease is low. Increasing sternotomy number and the presence of a right ventricle–pulmonary artery conduit are risk factors for reentry injury. However, reentry injury is not associated with increased risk of operative mortality.