[Retrospective analysis of 147 cases of reoperations in congenital heart disease]

Abstract

To analyse the clinical data of reoperations in congenital heart disease and discuss the management strategy of reoperation for congenital heart disease. Methods: We retrospectively studied the clinical data for patients underwent reoperation in congenital heart disease in Cardiovascular Surgery, Second Xiangya Hospital, Central South University from January 2007 to December 2015. Demographic and operative details, in-hospital mortality and major postoperative complications were analysed. Results: A total of 8 647 congenital heart disease surgery procedures were performed, including 147 (1.7%) reoperations. Among the patients, residual septal defect repair (30 cases, 20.4%), planed staged operation (28 cases, 19.0%), and Fontan procedure (20 cases, 13.6%) were the most common kinds of reoperation. In addition, 140 (95%) operations were through repeat sternotomies, 144 (98%) patients underwent operation with cardiopulmonary bypass, and 100 (68%) with cardiac arrest. Cardiopulmonary bypass and aortic cross clamp were maintained for 21-447 (135.5±87.8) minutes and 0-202 (49.9±49.7) minutes. There were 10 in-hospital deaths with a total mortality of 6.8%. The major complications included low cardiac output syndrome (24 cases, 16.3%), renal dysfunction (7 cases, 4.8%), respiratory insufficiency (14 cases, 9.5%), unplanned reoperations for drainage of haemorrhagic cardiac tamponade (4 cases), and delayed sternal closure (2 cases). Conclusion: Repeat sternotomy is the main way of reoperation, but it is not a major risk for operative mortality and morbidity. Improving the management of complex malformation, standardizing the follow-up, choosing the right timing of surgery, and reducing surgical complications will help reduce the risk of reoperation.