title: Two approaches for repeat cardiac surgery.
abstract: BACKGROUND
  With recent advances in post-operative care and surgical methods, the number of cardiovascular re-operations is increasing. We analyzed our institutional experience to evaluate the safety and efficacy of the approach methods for cardiac re-operations.
  
  
  METHODS
  Between September 2007 and December 2010, we performed 208 cardiac re-operations, defined as surgery which was not performed within a month from the previous operation or during the same hospitalization for the same disease and reviewed retrospectively. According to the surgical approach, we divided patients into two groups: median sternotomy group (S-group, n = 146), and thoracotomy group (T-group, n = 62).
  
  
  RESULTS
  There were no differences in sex or mean interval from the first surgery to re-operation between the two groups. Mean cardiopulmonary bypass, adhesion dissection time, bleeding control time, and operation time were significantly shorter in the T-group. The need for transfusion (p = 0.001) during adhesion dissection and the chest tube drainage (p < 0.001) were significantly lower in the T-group. There were 10 operative deaths in the S-group (6.8%) and 5 in the T-group (8.1%) (p = 0.757). Pneumonia was the most common cause of death in both groups. Post-operative bleeding did not result in death and there were no cases of wound infection in the T-group.
  
  
  CONCLUSIONS
  Two approaches for repeated cardiac surgery were safe and effective in terms of mortality, wound infection, bleeding, operation time, adhesion dissecting time, and bleeding control time. We were able to obtain a good visual field and perform safe surgery by applying the thoracotomy method in selective patients for cardiovascular re-operation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-701, South Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Chung
authors.forename: Hyun Keun
authors.initials: HK
authors.lastname: Chee
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods