Reoperative Cardiac Surgery: Part I – Preoperative Planning


  • Curt Tribble, MD Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia, USA



While reoperative cardiac surgery has become safer in recent years, it is still more difficult and dangerous than a primary operation. In a recent review of the Cleveland Clinic’s experience, 7% of the patients undergoing cardiac reoperations had major intraoperative adverse events (IAEs). In that report, if an IAE occurred, there was a 5% mortality and a 19% incidence of myocardial infarction (MI), stroke, or death [Roselli 2011]. Those are sobering statistics, particularly when reported by one of the busiest cardiac surgical services in the world. The take-home message is that reoperative cardiac surgery is riskier than primary cardiac operations and that there are strategies that should be employed at each juncture to lower the risks of a reoperation.

However, many of these strategies and recommendations have been more implicit than explicit. In fact, surprisingly little has been written about reoperative cardiac surgery. Thus, it seems appropriate to collect some of the lessons, adages, tricks, and tools that might make reoperations a click safer.


Blackbourne L, Tribble C, Langenburg S, et al. Optimal timing of abdominal aortic aneurysm repair after coronary artery revascularization. Ann Surg 219:693-6.

Flege J. 1987. Pericardial Incision for Internal Mammary Artery Coronary Bypass. Ann Thorac Surg 44:424.

Kaushal S, Patel S, Goh S, et al. 2011. A novel combination of bioresorbable polymeric film and expanded polytetrafluoroethylene provides a protective barrier and reduces adhesions. Thorac Cardiovasc Surg 141:789-95.

LaPar D, Ailawadi G, Harris D, et al. 2013. A protocol-driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy. Ann Thor Surg 96:865-70.

Lee A, Moon M. 2014. Reoperative Aortic Valve Replacement After Previous Coronary Artery Bypass Grafting or Aortic Valve Replacement. Op Tech Thor Card Surg 19:482-99.

Machiraju V. 1997. Redo Cardiac Surgery in Adults. CME Network Publishing, Southampton, NY. Library of Congress Catalog Card Number: 97-069143.

Roselli E. 2011. Reoperative Cardiac Surgery: Challenges and Outcomes. Tex Heart Inst Journal 38:669-71.

Schulman P. Perioperative Management of Patients with a Pacemaker or Implantable Cardioverter-defibrillator. UpToDate. 10-17.



How to Cite

Tribble, MD, C. (2018). Reoperative Cardiac Surgery: Part I – Preoperative Planning. The Heart Surgery Forum, 21(1), E063-E069.