Risks of repeat sternotomy in pediatric cardiac operations

Background. Repeat sternotomy has been associated with increased perioperat ive risks. Methods. We reviewed 165 patients undergoing 192 repeat sternotomies betwee n January 1985 and January 1997 (group 1) and a control group of 184 patien ts (group 2). The operations in group 1 were valve procedures in 94 patient s, Fontan procedure in 46, ventricular septal defect closure in 10, pulmona ry arterioplasty in 17, and others in 25; in group 2 ventricular or atrial septal defect closure in 120 patients, tetralogy of Fallot repair in 26, va lve procedures in 16, bidirectional Glenn anastomosis in 7,repair of transp osition of the great arteries in 7, pulmonary arterioplasty in 4, and other s in 4. Results. The hospital mortality was 2.6% in group 1 and 3.8% in group 2. Ca rdiac laceration occurred in 10 of 192 patients (5.2%), requiring emergent femorofemoral bypass in 6 patients. Two patients sustained an air embolism that was successfully treated with a hyperbaric chamber. Median total blood loss and requirements were not significantly different between the two gro ups. The length of stay in the intensive care unit and in the hospital were 4 days (range, 1 to 80 days) and II days (range, I to 135 days) in group I ,and 2 days (range, I to 87 days) and 7 days (range, I to 131 days) in grou p 2 (p < 0.02 and p < 0.002, respectively). The rate of complications was n ot significantly different in group 1 versus group 2. Overall survival was 97% (group 1) and 95% (group 2) at 120 months' follow-up (not significant). Conclusions. With careful surgical technique and judicious use of femorofem oral bypass, the risk of repeat sternotomy is minimized. (C) 1998 by The So ciety of Thoracic Surgeons.