Reoperations in Cardiac Surgery

Section I: General.- 1 Investigation Before Reoperations for Congenital Heart Disease.- Staged Procedures.- Residual Lesions.- Clinical Considerations.- Non-invasive Investigation.- Invasive Investigation.- Recurrent Lesions.- Changes Resulting from Growth, and Deterioration in Prosthetic Function.- Prognosis After Completion of Intended Management.- Conclusion.- 2 Investigations Before Reoperation for Acquired Heart Disease.- Methods of Investigation.- Non-invasive Investigation.- Invasive Investigation.- Reasons for Failure of Previous Operations.- Wrong Indication or Wrong Operation.- Valve Disease.- After Pericardiectomy.- Special Problems.- The Myocardium.- Marfan’s Syndrome.- Myxoma and Other Cardiac Tumours.- Pregnancy.- Traumatic Heart Disease.- Emergencies.- Mechanical Disasters.- Prosthetic Valve Thrombosis “Encapsulation”.- Infective Endocarditis.- Reoperation After Previous Coronary Bypass Surgery.- Pericardial Syndromes.- Postoperative Pericardial Collection.- Conclusion.- 3 Anaesthesia for Cardiac Reoperations.- Preoperative Assessment.- Anaesthesia.- Monitoring.- Specific Conditions.- Reoperation for Coronary Artery Bypass Grafts.- Valvar Heart Disease.- Congenital Heart Disease.- Postoperative Complications.- Conclusion.- 4 Approaches to the Heart and Great Vessels at Reoperation.- Sternal Re-entry.- Prevention.- Operative Technique.- Results.- Re-thoracotomy.- Conclusion.- 5 Reoperations in the Presence of Infection.- General Considerations.- Indications for Surgery.- Prosthetic Valve Endocarditis.- Infected Aortocoronary Bypass.- Infected Cardiac Suture Line.- Surgical Technique.- Reoperation in the Presence of Infected Prosthetic or Bioprosthetic Valves.- Surgical Technique for the Infected Cardiac Suture Line.- Surgical Treatment of Infected Coronary Bypass Graft.- Results.- Conclusions and Summary.- 6 Pacing: Indications, Technique of Insertion and Replacement of Leads and Generators.- Description of Generators.- Indications for Permanent Pacemaker Insertion.- Choice of Pacing Systems.- Generator.- Wire.- Pacing.- Temporary.- Permanent.- Generator Implantation.- Pectoral/Axillary Approach.- Subxiphoid Approach.- Suprarenal Approach.- Reoperation.- Pulse Generator Replacement.- Pacemaker Lead Problems.- Pacemaker System Replacement for Infection.- Follow-up.- Restrictions.- Conclusion.- 7 Postoperative Mediastinitis.- Aetiology.- Bacteriology.- History of Management Options.- Sternal Blood Supply.- Reconstructive Options.- Omentum.- Pectoralis Major.- Rectus Abdominis.- Complications.- Mediastinitis in Infants and Children.- Conclusions.- 8 Heart and Lung Retransplantation.- Cardiac Retransplantation.- Indications for Retransplantation.- Technique of Retransplantation.- Postoperative Care.- Results at Stanford University Hospital.- Summary.- Heart-Lung Retransplantation.- Indications for Retransplantation.- Technique of Retransplantation.- Postoperative Care.- Results.- Summary.- Section II: Congenital Heart Disease.- 9 Reoperations After Repair of Coarctation of the Aorta.- Problems Following Repair of Coarctation.- Residual/Recurrent Coarctation (Re-coarctation).- Aneurysm/Pseudoaneurysm.- Chylothorax.- Phrenic Nerve Palsy.- Vocal Cord Palsy.- Systemic Hypertension.- Operative Technique.- Re-coarctation.- Repair of Aneurysm/Pseudoaneurysm.- Results.- Residual/Recurrent Coarctation of the Aorta.- Aneurysm/Pseudoaneurysm.- 10 Reoperations for Interrupted Aortic Arch.- Problems.- Stenosis of the Aortic Anastomosis.- Subvalvar Stenosis.- Valvar Stenosis.- Supravalve Stenosis.- Residual VSD.- Previous Palliation.- Operative Techniques.- Techniques for First Operation.- Technique for Reoperation.- Postoperative Care.- Results.- Conclusion.- 11 Reoperations After Repair of Total Anomalous Pulmonary Venous Connection.- Problems.- Complications Requiring Medical Management.- Complications Requiring Surgical Management.- Surgical Technique.- Original Operation.- Reoperation.- Postoperative Management.- Results.- Early Results — Mortality After the Primary Operation.- Late Deaths Following the Primary Operation.- 12 Reoperations After Closure of Ventricular Septal Defects.- Problems.- Residual or Recurrent Intracardiac Shunt.- Arterial Valve Damage.- Atrioventricular Valve Dysfunction.- Outflow Tract Obstructions.- Haemolysis.- Postoperative Bacterial Endocarditis.- Conduction Disturbances.- Surgical Techniques.- Residual/Recurrent Intracardiac Shunts.- Additional VSDs.- Aortic Valve Regurgitation.- Atrioventricular Valve Dysfunction.- Outflow Tract Obstructions.- Haemolysis.- Endocarditis.- Pacemaker Insertion.- Postoperative Care.- 13 Reoperations After Repair of Tetralogy of Fallot.- Problems, Diagnosis and Indication for Reoperation.- Residual or Recurrent VSD.- Residual RVOTO.- Pulmonary Insufficiency.- Tricuspid Valve Insufficiency.- Right Ventricular Aneurysm.- Residual ASD.- Residual Surgical Shunt.- Surgical Technique.- Repair of Residual or Recurrent VSD.- Repair of RVOTO.- Repair of Pulmonary Insufficiency.- Repair of Tricuspid Valve Insufficiency.- Repair of Right Ventricular Aneurysm.- Repair of ASD.- Repair of Residual Surgical Shunt.- Postoperative Care.- Results.- 14 Reoperations After Mustard and Senning Operations.- Problems.- Mustard Operation.- Senning Operation.- Operative Technique.- Mustard.- Senning.- Results of Reoperations After Mustard or Senning Procedures.- 15 Reoperations After Arterial Switch Operation.- Complications.- Surgical Technique.- Original Operation.- Reoperation.- Results.- 16 Arterial Switch for Right Ventricular Failure Following Mustard or Senning Operations.- Problems.- Related to Previous Atrial Repair.- Related to the Concept of Atrial Repair.- Management and Surgical Technique.- Stage I. Pulmonary Artery Banding for RV Failure After Mustard/Senning.- Stage II. Conversion of Mustard/Senning to Arterial Switch.- 17 Aortic Valve Reoperations.- Secondary Aortic Valvotomy for Congenital Valvar Aortic Stenosis.- Problems.- Indication for Reoperation.- Surgical Technique.- Postoperative Care.- Results.- Secondary Aortic Valve Replacement.- Problems.- Indications for Reoperation.- Operative Technique.- Postoperative Care.- Results.- Enlargement of the Small Aortic Annulus.- Problems and Indications for Reoperation.- Operative Technique.- Results.- 18 Reoperations for Residual/Recurrent Left Ventricular Outflow Tract Obstruction.- Problems Following Initial Aortic Valvotomy.- Residual/Recurrent Aortic Stenosis.- Aortic Insufficiency.- Coronary Artery Insufficiency.- Supravalvar Aortic Stenosis.- Subvalvar Aortic Stenosis.- Problems Following Operative Repair of Subvalvar Aortic Stenosis.- Conduction Problem.- Aortic Valve Injury.- Mitral Valve Injury.- Ventricular Rupture.- Diagnosis and Evaluation.- Operative Technique.- Konno Aortoventriculoplasty.- Left Ventricle to Aorta Conduit.- Postoperative Management.- Results.- 19 Aortic Root Replacement.- Indications for Reoperation.- Left Ventricular Outflow Tract Obstruction.- Aortic Regurgitation.- Structural Defects.- Endocarditis.- Operative Technique of Aortic Root Replacement.- General Considerations.- Homograft Replacement of the Aortic Root.- Reoperation After Homograft Aortic Root Replacement.- Postoperative Management.- Results.- 20 Reoperations in Patients with Extracardiac Valved Conduits.- Problems.- Complications Related to Conduit Insertion.- Complications Unrelated to Conduit Insertion.- Operative Technique.- General.- Sternal Re-entry, Re-thoracotomy and Cannulation.- Conduit Replacement.- Replacement of Systemic (Tricuspid) Atrioventricular Valve in Patients with Congenitally Corrected Transposition.- Truncal Valve Incompetence.- Recurrent/Residual VSD.- Conduit or Ventricular Aneurysm/Pseudoaneurysm.- Recurrent/Residual Left Ventricular Outflow Tract Obstruction.- Residual/Recurrent Pulmonary Branch Stenoses.- Residual/Recurrent Major Aortopulmonary Collaterals.- Infection.- Postoperative Care.- Results.- 21 Reoperations After the Fontan Procedure.- Diagnosis of Problems and Indications for Reoperation.- Early Problems.- Late Problems.- Surgical Techniques/Treatment.- Early Problems.- Late Problems.- Postoperative Care.- Results.- 22 Reoperations for Atrioventricular Discordance.- Problems.- Recurrent or Increasing LVOTO.- Residual/Recurrent VSDs.- Systemic Atrioventricular Valve Regurgitation and Systemic Ventricular Failure.- Conduction Disturbances.- Surgical Considerations.- Anatomical Landmarks.- Surgical Techniques.- Postoperative Care.- Results.- Section III: Acquired Heart Disease.- 23 Reoperations for Coronary Artery Disease.- Incidence.- Indications for Reoperation.- Surgical Technique.- Results.- Conclusions.- 24 Reoperations on the Mitral and Tricuspid Valves.- Mitral Valve.- Problems.- Mitral Valve Conservative Surgery.- Causes and Incidence of Re-stenosis.- Causes and Incidence of Residual/Recurrent Regurgitation.- Diagnosis of Valve Malfunction and Timing of Reoperation.- Mitral Valve Replacement.- Surgical Technique.- Prosthesis-related Problems.- Patient-related Problems.- Operative Technique:Access to Mitral Valve.- Operative Technique: Surgery After Mitral Reconstruction.- Operative Technique: Valve Re-replacement.- Tricuspid Valve.- Problems.- Tricuspid Problems Overlooked During the Original Operation.- After Commissurotomy and Annuloplasty.- After Tricuspid Valve Replacement.- Operative Technique.- Access to Tricuspid Valve.- Reoperation on Triscuspid Valve.- Postoperative Care.- Results.- 25 Reoperations in the Surgical Treatment of Arrhythmias.- Reoperations for WPW.- Diagnosis and Indications.- Surgery.- Postoperative Care.- Results.- Reoperations for Direct Surgical Relief of Ventricular Tachycardia.- Diagnosis and Indications.- Surgery.- Postoperative Care.- Results.- Implantation of the Automatic Cardioverter/Defibrillator After Previous Sternotomy.- Diagnosis and Indications.- Surgery.- Postoperative Care.- Results.- 26 Reoperations for Thoracic and Thoracoabdominal Aneurysms.- Involvement of Multiple Aortic Segments.- Progression of Disease.- Problems.- Ascending Aorta and Aortic Arch.- Descending and Thoracoabdominal Aorta.- Diagnosis.- Operative Technique.- Perfusion Techniques and Hypothermia.- Current Reconstruction Techniques.- Results of Reoperation.- Ascending Aorta and Aortic Arch.- Descending and Thoracoabdominal Aorta.