title: Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation: what is the operative risk?
abstract: OBJECTIVE
  There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation.
  
  
  METHODS
  We conducted a retrospective review of 629 octogenarian patients with aortic stenosis who received isolated surgical aortic valve replacement between January 1993 and December 2011. Patient characteristics included age 83.7±3.2 years, male sex in 322 patients (51.2%), and Society of Thoracic Surgeons predicted risk of mortality of 6.2%±4.4%. Operations included a primary sternotomy in 518 patients (82.4%) and a repeat sternotomy in 111 patients (17.6%) who had previous coronary artery bypass graft operation. Patients with other cardiac operations were excluded from the study.
  
  
  RESULTS
  Cardiopulmonary bypass time was longer with repeat sternotomy (88.0±45.7 minutes) in comparison to primary sternotomy (66.5±25.1; P<.001); but there was no difference in the aortic crossclamp time (51.1±19.7 minutes vs 49.2±17.7 minutes; P=.282). Stroke occurred in 3 patients (2.7%) following repeat sternotomy and in 10 (1.9%) after primary sternotomy (P=.710). Rates of myocardial infarction, renal failure, and reoperation for bleeding were similar between the 2 groups. Operative mortality occurred in 7 patients (6.4%) after repeat sternotomy and in 19 patients (3.7%) following primary sternotomy (P=.196). Repeat sternotomy was not predictive of operative mortality.
  
  
  CONCLUSIONS
  Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Sebastian A
authors: SA
authors: Iturra
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: greason.kevin@mayo.edu.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Rakesh M
authors: RM
authors: Suri
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Lyle D
authors: LD
authors: Joyce
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: John M
authors: JM
authors: Stulak
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Alberto
authors: A
authors: Pochettino
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Hartzell V
authors: HV
authors: Schaff
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome