Reoperations in congenital heart surgery: causes, surgical techniques, and results in 108 patients

OBJECTIVES
We evaluated the causes of reoperations, surgical techniques, and results of patients who had undergone a previous repair by sternotomy for congenital heart defects.

STUDY DESIGN
The study included 108 patients (59 males, 49 females; mean age 10.2±9.7 years; range 9 days to 58 years) who required a reoperation following a repair by sternotomy. A right thoracotomy was performed in three patients, Clamshell incision in three patients, and resternotomy in 102 patients. Thirty-three patients under-went total repair follovving a palliative procedure, while six patients underwent a subsequent palliative procedure. Other reoperations were performed for the follovving: right ventricle outflow tract (n=21), atrioventricular valve (n=16), left ventricle outflovv tract (n=13), Fontan revisions (n=7), arterial switch/double svvitch reoperations (n=7), pulmonary venous retum restenosis (n=2), residual/recurrent atrial/ventricular septal defect (n=2), tricuspid regurgitation and arrhythmia after the Senning operation (n=1).

RESULTS
Hospital mortality occurred in nine patients (8.3%). Thirteen patients (13.1%) experienced a prolonged intensive care unit stay (>1 week). During sternal reentry major hemorrhage occurred in two patients, one of whom died. Postoperative complications included re-exploration for bleeding (n=2), permanent pacemaker implantation (n=2), tracheostomy (n=6), pleural effusion (n=7), pneu-mothorax (n=1), chylothorax (n=1), right diaphragmatic paralysis (n=3), and transient cerebrovascular event (n=1).

CONCLUSION
The majority of reoperations after repair of congenital heart defects are due to staged repairs or to inevitably ensuing problems. Proper indications and tim-ing are essential dependi