Redo Cardiac Surgery in Adults (eBook)

Redo Cardiac Surgeryin Adults 3
Preface to the Second Edition 5
Contents 7
Contributors 9
1: Problems Related to Redo Cardiac Surgery 11
Introduction 11
Redo Sternotomy and Institution of Cardiopulmonary Bypass 12
Calcified Ascending Aorta 12
Coronary Sinus Perfusion 13
Limited Surgical Dissection 13
Exposure of the Mitral Valve While Limiting Dissection 13
De-airing of the Heart 13
Low Cardiac Output Syndrome 14
Vasoplegic Syndrome 14
Emergency Redo Cardiac Surgery 15
Conclusion 15
References 15
2: Practical Approaches to the Current “On-Pump” Redo Coronary Artery Bypass Surgery 17
Introduction 17
Technical Demands 18
Redo Sternotomy 18
Patent ITA Grafts 19
Institution of Cardiopulmonary Bypass 21
Myocardial Protection During Redo Cardiac Surgery 21
Vein Graft Failure and Prevention of Vein Graft Atheroembolism 23
Management of Perioperative Hemorrhage 24
Conduits for Bypass Surgery 25
Internal Thoracic Artery 25
Preparation of Venous Conduits 25
Radial Artery 26
Alternative Conduits 27
Indications for Redo Coronary Artery Bypass Surgery 27
Identifying Coronary Artery Branches 27
Combined Surgical Procedures 28
Conclusions 28
References 28
3: Off-Pump Coronary Artery Bypass Grafting for Repeat Coronary Revascularization 30
Patient Selection 31
Operative Strategy 31
Distal Anastomosis 33
Proximal Anastomosis 34
Alternative Approaches 35
Outcomes 35
References 36
4: Management of Perioperative Stroke 37
Introduction 37
Perioperative Stroke Risk 37
Coexistent Coronary and Carotid Disease 38
Stroke Prevention in Cardiac Surgery 38
Treatment of Perioperative Stroke 39
Summary 41
References 41
5: Acute Kidney Injury Associated with Cardiac Surgery 44
Introduction 44
Incidence and Prognosis of ARF After Bypass Surgery 44
Risk Factors Associated with ARF 45
Predictive Scoring Systems 46
Pathogenesis of ARF 47
Preoperative Events 48
Intraoperative Events 49
Hemodynamic Effects 49
Inflammation 50
Other Events Associated with CPB 51
Postoperative Events 52
General Measures to Prevent AKI After Cardiac Surgery 52
Identification of High-Risk Patients 52
Optimization Renal Perfusion and Avoidance of Nephrotoxins 52
Pharmacological Interventions to Prevent AKI Following Cardiac Surgery 52
Drugs That Increase Renal Blood Flow 52
Drugs That Induce Natriuresis 53
Drugs That Block Inflammation 53
Other Strategies 53
Summary 54
References 54
6: Pulmonary Factors in Redo Open Heart Surgery 60
References 62
7: Transfusion Therapy in Reoperative Cardiac Surgery 63
Management of Bleeding 64
Red Cell Component Selection 65
Recombinant VIIa 66
Conclusions 66
References 67
8: Anesthesia for Redo Cardiac Surgery 68
References 70
9: Options for Advanced Mechanical Support for Cardiogenic Shock Complicating Cardiac Reoperations 71
Intra-Aortic Balloon Pump 74
Extracorporeal Membrane Oxygenation 75
Thoratec Paracorporeal Ventricular Assist Device 77
Abiomed BVS 5000 and AB 5000 Assist Devices 77
Levitronix CentriMag 78
Considerations for Biventricular Support 79
TandemHeart 80
The Abiomed Impella 5.0 and LD 81
Summary 82
References 82
10: Reoperations for Mitral Valve Disease: Surgical Approaches and Techniques 85
Introduction 85
Preoperative Preparation 85
Examination 85
Preoperative Imaging 86
Hemostasis 87
Intraoperative Preparation 87
Choice of Incision 88
Resternotomy 88
Right Thoracotomy 90
Minimally Invasive MV Reoperation 90
References 91
11: Reoperation Following Mitral Valve Repair 92
Introduction 92
Indications for Surgery 92
Surgical Methods 93
Mitral Valve Re-Repair vs. Mitral Valve Replacement 95
Outcomes of Reoperation for Recurrent Mitral Regurgitation 98
Clinical Implications 99
References 99
12: Reoperation for Prosthetic Mitral Valve Endocarditis 101
Introduction 101
Pathology 101
Diagnosis 101
Indication for Operation 102
Timing of Operation 102
Early Prosthetic Valve Endocarditis 102
Late Prosthetic Valve Endocarditis 102
Cerebrovascular Complications 103
Operative Techniques 103
Surgical Approach 103
Institution of Cardiopulmonary Bypass 104
Atriotomy 104
Removal of the Prosthetic Valve and Debridement 104
Reconstruction 105
Valve Choice 107
Results 108
References 109
13: Surgical Management of Atrial Fibrillation in Redo Cardiac Operations 111
Reoperative Cardiac Surgery 111
Indications 111
Congenital Heart Disease 112
Valvular Heart Disease 113
Surgical Techniques 114
Cut and Sew Biatrial Maze Procedure 114
Alternate Energy Sources 115
Cut and Sew Right-Sided Maze Procedure 116
Alternate Lesion Sets 116
Prophylactic Maze Procedure 117
Postoperative Management 117
Mayo Clinic Experience 118
Patients 118
Results 118
Late Outcome 118
Summary 119
References 120
14: Surgical Management of Tricuspid Valve Disorders 122
Introduction 122
Pathology 122
Risk Factors 122
Tricuspid Regurgitation 123
Symptomatic Tricuspid Valve Regurgitation 124
Management of Patients with Decompensated TR 124
Management of Tricuspid Valve Endocarditis 124
Conclusions 125
References 125
15: Reoperation for Aortic Valve Disease 126
Introduction 126
Reoperation on the Aortic Valve After Coronary Bypass, Aortic Valve Repair, and Percutaneous Options 126
Cardiopulmonary Bypass Before Sternotomy 126
Cardiopulmonary Bypass After Sternotomy 127
Results 128
Percutaneous Valve Insertion After Previous Cardiac Operations 128
References 132
16: Reoperation Following Homograft Aortic Valve Replacement 133
Preoperative Evaluation 134
Operative Strategy 136
Postoperative Management 139
Reoperation Following the Ross Procedure 139
References 139
17: Prosthetic Aortic Valve and Root Endocarditis 140
Introduction 140
Pathophysiology and Pathology 140
Prosthetic Aortic Valve Endocarditis 140
Ascending Aorta and Arch Graft Infection 142
Microbiology 142
Diagnosis 142
Echocardiography 143
Coronary Angiography 144
Brain Imaging 144
CT and MRI of the Chest 145
Additional Diagnostic Tests are Performed as Clinically Indicated 145
Indications for Surgery 145
Timing of Surgery and Preoperative Considerations 145
Operative Technique 146
Sternal Reentry and Myocardial Protection 146
Radical Debridement 147
Replacement Choice for the Aortic Valve and Root 147
Double Valve Endocarditis with Destruction of the Intervalvular Fibrosa 148
Surgical Specimens 148
Postoperative Management, Antibiotic Treatment, and Follow-Up 148
Outcomes 149
Recommended Readings 149
18: Reoperation on the Aortic Arch 150
Introduction 150
Hemiarch 150
Extended Aortic Arch Replacement Including the Proximal Descending Aorta with a Long Tongue 150
Replacement of the Aortic Arch and Insertion of an Elephant Trunk into the Descending Aorta 152
Aortic Arch Replacement with Individual Bypasses to the Greater Vessels and the Elephant Trunk Procedure 154
Debranching of the Aortic Arch Without Replacement of the Aortic Arch and Proximal Descending Aorta via Open Methods 154
References 155
19: Descending and Thoracoabdominal Aortic Reoperations 156
Introduction 156
Classification of Descending and Thoracoabdominal Aortic Aneurysms 156
Etiology 157
Natural History 158
Preoperative Evaluation 159
Operative Techniques 159
Descending Thoracic Aorta 161
Thoracoabdominal Aorta 163
Postoperative Management 163
Spinal Cord Protection 163
Renal and Visceral Protection 165
Alternative Surgical Options 165
Branched–Fenestrated Stent grafts 165
Hybrid Visceral Debranching and Stent Graft Exclusion 167
Results 167
References 168
20: Reoperations Following Endovascular Aortic Repair 170
Introduction 170
Endoleaks 170
Type Ia Proximal Endoleaks 171
Operative Approach 174
Type Ib Distal Endoleaks and Chronic Distal Dissections 175
Operative Technique 177
Type II Endoleaks 179
Operative Techniques 180
Type III Endoleaks 180
Operative Techniques 182
Migration 182
Treatment 183
Stent Collapse 184
Treatment 185
Proximal Dissection 186
Treatment 187
Infection 187
Treatment 188
Access Site Injury 189
Miscellaneous Failed Endovascular Procedures 190
Conclusions 191
References 191
21: Percutaneous Approaches to Valvular Heart Disease After Previous Cardiac Surgery 193
Introduction 193
Aortic Valve 193
Pulmonary Valve 194
Mitral Valve 195
Tricuspid Valve 196
Paravalvular Leak 196
Future Directions 196
References 196
Index 199