Experienced surgeons, when estimating the risk of surgical procedures, approximately double the predicted mortality when the procedure involves a reoperation. In fact, between 2003 and 2010, the New York State Cardiac Surgery Database predicted that patients undergoing valve and coronary procedures experienced an incremental odds ratio of between 1.5 and 2.1 if they had previously undergone open heart procedures [1Cardiovascular Disease Data and Statistics. New York State Department of Health. Available at: http://www.health.ny.gov/statistics/diseases/cardiovascular/. Accessed June 4, 2013.Google Scholar].In reviewing their results with 130 patients undergoing repeat surgical procedures through sternotomy, Ghoreishi and coauthors [2Ghoreishi M. Dawood M. Hobbs G. et al.Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures.Ann Thorac Surg. 2013; 96: 1358-1366Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar] have shown that selected reoperative mitral valve procedures can be performed at a risk level equivalent to that of first-time operations. This somewhat counterintuitive result is attributable to careful planning and technique. Their work helps to establish best practices, including appropriate selection of patients for sternal versus thoracotomy reentry, preoperative risk stratification with computed tomographic scanning, preemptive exposure and in some cases cannulation of the femoral vessels, avoidance of lateral traction on mediastinal tissues during separation of the sternum, avoidance of dissection of patent internal thoracic artery grafts, and (presumably) careful attention to myocardial protection, particularly in patients with previous coronary grafts.The lateral thoracotomy approach to the reoperative mitral valve procedure has been widely advocated and remains a useful tool in the surgeons' repertoire, especially for patients with hostile mediastina, radiation, previous muscle flaps, aortic pathologic conditions, prior aortic and aortic valve surgical procedures, and other situations in which sternal division is hazardous. Nonetheless, these authors have taught us that sternal reentry need not substantially increase surgical risk, much less double it. Experienced surgeons, when estimating the risk of surgical procedures, approximately double the predicted mortality when the procedure involves a reoperation. In fact, between 2003 and 2010, the New York State Cardiac Surgery Database predicted that patients undergoing valve and coronary procedures experienced an incremental odds ratio of between 1.5 and 2.1 if they had previously undergone open heart procedures [1Cardiovascular Disease Data and Statistics. New York State Department of Health. Available at: http://www.health.ny.gov/statistics/diseases/cardiovascular/. Accessed June 4, 2013.Google Scholar]. In reviewing their results with 130 patients undergoing repeat surgical procedures through sternotomy, Ghoreishi and coauthors [2Ghoreishi M. Dawood M. Hobbs G. et al.Repeat sternotomy: no longer a risk factor in mitral valve surgical procedures.Ann Thorac Surg. 2013; 96: 1358-1366Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar] have shown that selected reoperative mitral valve procedures can be performed at a risk level equivalent to that of first-time operations. This somewhat counterintuitive result is attributable to careful planning and technique. Their work helps to establish best practices, including appropriate selection of patients for sternal versus thoracotomy reentry, preoperative risk stratification with computed tomographic scanning, preemptive exposure and in some cases cannulation of the femoral vessels, avoidance of lateral traction on mediastinal tissues during separation of the sternum, avoidance of dissection of patent internal thoracic artery grafts, and (presumably) careful attention to myocardial protection, particularly in patients with previous coronary grafts. The lateral thoracotomy approach to the reoperative mitral valve procedure has been widely advocated and remains a useful tool in the surgeons' repertoire, especially for patients with hostile mediastina, radiation, previous muscle flaps, aortic pathologic conditions, prior aortic and aortic valve surgical procedures, and other situations in which sternal division is hazardous. Nonetheless, these authors have taught us that sternal reentry need not substantially increase surgical risk, much less double it. Repeat Sternotomy: No Longer a Risk Factor in Mitral Valve Surgical ProceduresThe Annals of Thoracic SurgeryVol. 96Issue 4PreviewThe incidence of reoperative mitral valve (MV) surgical procedures is increasing, representing more than 10% of all MV operations in the United States. Previous clinical series have reported mortality rates of 5% to 18% and reentry injury rates of 5% to 10% for reoperative MV operations. Full-Text PDF