Abstract：
OBJECTIVE: Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution.
METHODS: Review of our institution\'s cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes.
RESULTS: Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome.
CONCLUSIONS: Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.
METHODS: Review of our institution\'s cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes.
RESULTS: Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome.
CONCLUSIONS: Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.
摘要：
目标：患有先天性心脏病（CHD）的患者越来越多地活到成年期，经常需要心脏再手术.我们旨在评估在我们机构接受重复胸骨切开术的成人冠心病（ACHD）患者的预后。
方法：对我们机构的心脏手术数据库的回顾确定了1,960名ACHD患者进行了1993-2023年的重复正中胸骨切开术。主要结局是早期死亡率，次要结局是死亡率和显著发病率的复合终点。使用单变量和多变量逻辑回归模型来确定与结果独立相关的因素。
结果：在1,960例接受重复胸骨切开术的ACHD患者中，1,183名患者（60.3%）接受了第二次胸骨切开术，第三（n=506，25.8%），第四（n=168，8.5%），第五（n=70，3.5%）和≥第六（n=33，1.6%）。冠心病诊断为：轻微复杂性（n=145，7.4%），中等复杂度(n=1380，70.4%)，和主要复杂性（n=435，22.1%）。程序分布包括瓣膜（n=549，28%），先天性（n=625，32%），主动脉（n=104，5.3%），和主要程序组合（n=682，34.7%）。总体早期死亡率为3.1%。与早期死亡率独立相关的因素是手术时年龄较大，复杂的冠心病，术前肾功能衰竭，术前射血分数,紧急行动,以及术后输血.此外,胸骨切开术数量和旁路时间与复合结局独立相关.
结论：尽管胸骨切开术后早期死亡率增加，胸骨切开术数量与早期死亡率无关,但与发病率增加相关.改进策略应针对导致紧急行动的因素，早期转诊,以及手术效率，包括旁路时间和血液保存。
方法：对我们机构的心脏手术数据库的回顾确定了1,960名ACHD患者进行了1993-2023年的重复正中胸骨切开术。主要结局是早期死亡率，次要结局是死亡率和显著发病率的复合终点。使用单变量和多变量逻辑回归模型来确定与结果独立相关的因素。
结果：在1,960例接受重复胸骨切开术的ACHD患者中，1,183名患者（60.3%）接受了第二次胸骨切开术，第三（n=506，25.8%），第四（n=168，8.5%），第五（n=70，3.5%）和≥第六（n=33，1.6%）。冠心病诊断为：轻微复杂性（n=145，7.4%），中等复杂度(n=1380，70.4%)，和主要复杂性（n=435，22.1%）。程序分布包括瓣膜（n=549，28%），先天性（n=625，32%），主动脉（n=104，5.3%），和主要程序组合（n=682，34.7%）。总体早期死亡率为3.1%。与早期死亡率独立相关的因素是手术时年龄较大，复杂的冠心病，术前肾功能衰竭，术前射血分数,紧急行动,以及术后输血.此外,胸骨切开术数量和旁路时间与复合结局独立相关.
结论：尽管胸骨切开术后早期死亡率增加，胸骨切开术数量与早期死亡率无关,但与发病率增加相关.改进策略应针对导致紧急行动的因素，早期转诊,以及手术效率，包括旁路时间和血液保存。
