Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation: what is the operative risk?

Abstract

There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation. We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7±3.2 years, male sex in 322 patients (51.2%), and Society of Thoracic Surgeons predicted risk of mortality of 6.2%±4.4%. Operations included a primary sternotomy in 518 patients (82.4%) and a repeat sternotomy in 111 patients (17.6%) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study. Cardiopulmonary bypass time was longer with repeat sternotomy (88.0±45.7 minutes) in comparison to primary sternotomy (66.5±25.1; P<.001); but there was no difference in the aortic crossclamp time (51.1±19.7 minutes vs 49.2±17.7 minutes; P=.282). Stroke occurred in 3 patients (2.7%) following repeat sternotomy and in 10 (1.9%) after primary sternotomy (P=.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4%) after repeat sternotomy and in 19 patients (3.7%) following primary sternotomy (P=.196). Repeat sternotomy was not predictive of operative mortality. Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.