RF67 REDO MITRAL SURGERY AND HOSPITAL OUTCOME: A MULTICENTRE EXPERIENCE REGARDING SURGICAL FACTORS AND COMPLICATIONS

Abstract

Background and Aim: Redo mitral surgery is an high risk procedure. Several preoperative conditions identify patients at unusual surgical risk. Few studies clarify technical issues and perioperative complications affecting early survival. The aim of this multicentre study is to determine predictors of adverse outcome among intraoperative factors and postoperative events. Methods: Operative mortality and major morbidity events from 832 redo mitral procedures, from January 2005 to December 2014 at eight European centres, were analysed. Statistical analysis was performed by the SPSS 13.0 program for Windows (SPSS, Inc., Chicago, IL, USA). Normally distributed continuous variables were compared using the unpaired t-test, not-normally distributed variables using the Mann–Whitney U-test and categorical variables using the χ2test. Only variables with a P < 0.10 at univariable analysis were included into the regression models. Results: Injury of a previous patent left internal mammary artery graft (LIMA) [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6–11.5; P = 0.005], major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI: 9.2–39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95% CI: 1.4–37.8; P = 0.018) and incremental cardiopulmonary bypass time (OR 1.1, 95% CI: 1.0–1.2; P = 0.001) independently predicted operative mortality. Conclusion: Operative mortality in redo mitral surgery is still significant. Injury of a previous LIMA graft identifies patients at higher. Prolonged cross-clamp times, extracellular crystalloid cardioplegia, massive transfusions, perioperative myocardial infarction, prolonged intubation also predict adverse early outcome. Combined antegrade + retrograde cardioplegia seems to be the only protective factor these high-risk patients.