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Aim of this study was to compare redo MV surgery patients undergoing right mini-thoracotomy and EAC with redo MV patients undergoing surgery through other approaches. Redo MV patients from 7 European centers were analyzed. Primary endpoint was 30-day mortality; secondary endpoints were stroke, re-exploration, low cardiac output syndrome (LCOS), respiratory failure, and intensive care unit (ICU) and in-hospital length-of-stay. Forty-nine patients underwent right mini-thoracotomy and EAC (22.7%), and 167 (77.3%) underwent surgery through other approaches (112 sternotomy, 40 unclamped mini-thoracotomies, and 15 mini-thoracotomies with trans-thoracic clamp). Thirty-day mortality, stroke, re-exploration for bleeding, and weaning failure were comparable. The EAC group showed significant lower rate of LCOS (p = 0.03) and shorter ICU (p = 0.04) and in-hospital length of stay (p = 0.002). The EAC allows the surgeon to reach the aorta, to clamp it, and to deliver the cardioplegia with a "no-touch" technique, with significant improvement in outcomes. [ABSTRACT FROM AUTHOR] more...

The risk of post-operatory hypothyroidism and hypocalcaemia, along with recurrent laryngeal nerve injury, is lower following a less-than-total thyroidectomy; however, a previously unsuspected carcinoma or a disease progression might be detected after initial surgery, hence indicating re-intervention as mandatory (so-called "redo" surgery) with completion. This decision takes into consideration a multidisciplinary approach, but the surgical technique and the actual approach is entirely based on the skills and availability of the surgical team according to the standard protocols regarding a personalised decision. We aimed to introduce a review of the most recently published data, with respect to redo thyroid surgery. For the basis of the discussion, a novel vignette on point was introduced. This was a narrative review. We searched English-language papers according to the key search terms in different combinations such as "redo" and "thyroid", alternatively "thyroidectomy" and "thyroid surgery", across the PubMed database. Inclusion criteria were original articles. The timeframe of publication was between 1 January 2020 and 20 July 2024. Exclusion criteria were non-English papers, reviews, non-human studies, case reports or case series, exclusive data on parathyroid surgery, and cell line experiments. We identified ten studies across the five-year most recent window of PubMed searches that showed a heterogeneous spectrum of complications and applications of different surgeries with respect to redo interventions during thyroid removal (e.g., recurrent laryngeal nerve monitoring during surgery, other types of incision than cervicotomy, the use of parathyroid fluorescence, bleeding risk, etc.). Most studies addressing novel surgical perspectives focused on robotic-assisted re-intervention, and an expansion of this kind of studies is expected. Further studies and multifactorial models of assessment and risk prediction are necessary to decide, assess, and recommend redo interventions and the most adequate surgical techniques. [ABSTRACT FROM AUTHOR] more...

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Despite promising success rates, redo ablation is sometimes required. At redo, PVs may be found to be isolated (silent) or reconnected. We studied patients with silent vs reconnected PVs at redo and analysed associations with adverse outcomes. Methods: Patients undergoing redo AF ablations between 2013 and 2019 at our institution were included and stratified into silent PVs or reconnected PVs. The primary outcome was a composite of further redo ablation, non-AF ablation, atrioventricular nodal ablation, and death. Secondary outcomes included arrhythmia recurrence. Results: A total of 467 patients were included with mean 4.6 ± 1.7 years follow-up, of whom 48 (10.3%) had silent PVs. The silent PV group had had more often undergone >1 prior ablation (45.8% vs 9.8%; p<0.001), had more persistent AF (62.5% vs 41.1%; p=0.005) and had more non-PV ablation performed both at prior ablation procedures and at the analysed redo ablation. The primary outcome occurred more frequently in those with silent PVs (25% vs 13.8%; p=0.053). Arrhythmia recurrence was also more common in the silent PV group (66.7% vs 50.6%; p=0.047). After multivariable adjustment, female sex (aHR 2.35 [95% CI 2.35–3.96]; p=0.001) and ischaemic heart disease (aHR 3.21 [95% CI 1.56–6.62]; p=0.002) were independently associated with the primary outcome, and left atrial enlargement (aHR 1.58 [95% CI 1.20–2.08]; p=0.001) and >1 prior ablation (aHR 1.88 [95% CI 1.30–2.72]; p<0.001) were independently associated with arrhythmia recurrence. Whilst a finding of silent PVs was not itself significant after multivariable adjustment, this provides an easily assessable parameter at clinically indicated redo ablation which informs the clinician of the likelihood of a worse future prognosis. Conclusions: Patients with silent PVs at redo AF ablation have worse clinical outcomes. [ABSTRACT FROM AUTHOR] more...

Background: Catheter ablation atrial fibrillation (AF) is effective, but 20% to 40% of patients will require a repeat ablation. The role of more than 1 repeat ablation is not well known. Objectives: The purpose of this study was to evaluate the effectiveness and incremental benefits of multiple repeat catheter ablations to treat AF in patients. Methods: We retrospectively included patients who underwent their first, second, third, and fourth AF ablation between 2004 and 2019. They were monitored with a 24-to-48-hour Holter every 3 months postablation the first year and every 6 to 12 months thereafter. Recurrence was defined as documented atrial arrhythmia >30 seconds. Outcomes are analyzed by Kaplan-Meier curves and compared by log rank test. Results: We included a total of 2,194 patients (64% with paroxysmal and 36% with nonparoxysmal AF). Mean age was 71 ± 10 years; 67% were male. After 1 ablation, freedom from AF was 52%. Among those 1,052 patients who had recurrences, 576 (55%) underwent a second ablation, 103 (10%) underwent a third procedure, and 20 (2%) underwent a fourth. Success rates for the second, third, and fourth ablation were 57%, 60%, and 40%, respectively, at 5-year follow-up. After the second ablation, freedom from AF in our entire cohort increased from 52% to 66%, with marginal changes after the third (67%) and fourth (67%) procedures. Conclusions: Although repeated ablations demonstrated significant benefits at the individual level, the success rate may drop off after a third. The overall success of the initial cohort was not significantly influenced by the success rates of multiple follow-up ablations. more...

Background: The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective: To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design, setting, and participants: We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score. Surgical procedure: Redo PN was performed by using the Si Da Vinci robotic platform. Measurements: Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated. Results and limitations: Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2–4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7–9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148–200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5–22) min. Pure enucleation (SIB score 0–1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0–1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16–45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively. Conclusions: Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney. Patient summary: Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy. more...

Background: Repeat hepatectomies are technically complex procedures. The evidence of robotic or laparoscopic (= minimally invasive) repeat hepatectomies (MIRH) after previous open hepatectomy is poor. Therefore, we compared postoperative outcomes of MIRH vs open repeat hepatectomies (ORH) in patients with liver tumors after previous open liver resections. Methods: Consecutive patients who underwent repeat hepatectomies after open liver resections were identified from a prospective database between April 2018 and May 2023. Postoperative complications were graded in line with the Clavien-Dindo classification. We stratified patients by intention to treat into MIRH or ORH and compared outcomes. Logistic regression analysis was performed to define variables associated with the utilization of a minimally invasive approach. Results: Among 46 patients included, 20 (43%) underwent MIRH and 26 (57%) ORH. Twenty-seven patients had advanced or expert repeat hepatectomies (59%) according to the IWATE criteria. Baseline characteristics were comparable between the study groups. The use of a minimally invasive approach was not dependent on preoperative or intraoperative variables. All patients had negative resection margins on final histology. MIRH was associated with less blood loss (450 ml, IQR (interquartile range): 200–600 vs 600 ml, IQR: 400–1500 ml, P = 0.032), and shorter length of stay (5 days, IQR: 4–7 vs 7 days, IQR: 5–9 days, P = 0.041). Postoperative complications were similar between the groups (P = 0.298). Conclusions: MIRH is feasible after previous open hepatectomy and a safe alternative approach to ORH. (German Clinical Trials Register ID: DRKS00032183) [ABSTRACT FROM AUTHOR] more...

Redo cardiac surgery after Coronary Artery Bypass Grafting (CABG) is burdened by high morbidity and mortality, either intraoperatively and postoperatively, with the repeated sternotomy playing a crucial role as risk factor. The right minithoracotomy approach guarantees a safer control on conduits integrity and the right ventricular wall and a low impact on the respiratory mechanics. Herein, we report a patient who previously underwent two CABG (coronary artery bypass grafting) procedures and who was admitted to the hospital with a picture of heart failure caused by a severe mitral regurgitation. He was successfully submitted to a mitral valve repair on a beating heart via the right minithoracotomy approach. [ABSTRACT FROM AUTHOR] more...

Introduction and hypothesis: In the case of recurrent apical prolapse following laparoscopic sacrocolpopexy (LSCP), one may consider a "redo" procedure. We hypothesized that redo LSCP may carry an increased complication risk and less favorable outcomes when compared with primary procedures. Methods: This is a single-center, matched case–control (1:4) study, comparing all 39 women who had a redo LSCP and 156 women who had a primary LSCP for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. Matching was based on proximity to the operation date. The primary outcome was the occurrence of intraoperative and early postoperative complications within 3 months. Secondary outcomes included subjective (Patient Global Impression of Change [PGIC] ≥4) and objective (Pelvic Organ Prolapse Quantification [POP-Q] stage <2) success rates, surgical variables, graft-related complications and reinterventions. Results: There was no difference in the rate of intraoperative and early postoperative complications (redo: 21.1% vs control: 29.8%, OR: 0.63, 95% CI 0.27–1.48). The conversion rate was higher in redo patients (redo: 10.3% vs control: 0.6, OR: 17.71, 95% CI 1.92–163.39). Early postoperative complications were comparable: they were mainly infectious and managed by antibiotics. At a comparable follow-up (redo: 81 months (IQR: 54) vs control: 71.5 months (IQR: 42); p=0.37), there were no differences in graft-related complications (redo: 17.9% vs control: 9.6%, p=0.14) and reinterventions for complications (redo: 12.8% vs control: 5.1%, p=0.14) or prolapse (redo: 15.4% vs control: 8.3%, p=0.18). Subjective (redo: 88.5% vs control: 80.2%, p=0.41) and objective (redo: 31.8% vs control: 24.7%, p=0.50) success rates were also comparable. Conclusions: In our experience, redo LSCP is as safe and effective as a primary LSCP, but there is a higher risk of conversion [ABSTRACT FROM AUTHOR] more...

Robotic surgery has been increasingly applied to Hirschsprung patients with encouraging results. We report the results of a 5 year unicentric experience. All consecutive HSCR patients older than 12 months who underwent a surgical procedure with robotic approach between September 2017 and August 2022 were prospectively included. We collected data regarding demographics, extent of aganglionosis, associated anomalies, indications to surgery, and a number of perioperative data such as surgical details, intraoperative and perioperative complications, length of surgery, length of hospital stay, and functional outcome. A total of 28 patients underwent 31 robotic procedures during the study period. Median age at surgery was 82 months. Eleven primary Totally Robotic Soave Pull-Through, 12 redoes, 5 innervative mapping, 2 redundant rectal pouch excision, and 1 Miles' procedures have been performed. Median console time was 145 min. No conversion to either laparoscopy nor to laparotomy was required. Median length of hospital stay was 6 days. Two patients experienced complications requiring reiterative surgery. One patient experienced mild postoperative enterocolitis. Normal continence was achieved by 70% of patients after a median of 16 months postoperatively (80% for primary pull-throughs, 55% for redoes). To conclude, robotic surgery for older HSCR patients proved to be feasible, safe, and effective. Patients with complex surgical requirements seem to benefit most from this promising approach. Provided the economic burden is addressed and solved, robotic surgery will represent an excellent alternative for the surgical treatment of HSCR patients. [ABSTRACT FROM AUTHOR] more...

Background and Objectives: Sutureless aortic valve prostheses have presented favorable hemodynamic performance while facilitating minimally invasive access approaches. As the population ages, the number of patients at risk for aortic valve reoperation constantly increases. The aim of the present study is to present our single-center experience in sutureless aortic valve replacement (SU-AVR) in reoperations. Materials and Methods: The data of 18 consecutive patients who underwent SU-AVR in a reoperation between May 2020 and January 2023 were retrospectively analyzed. Results: The mean age of the patients was 67.9 ± 11.1 years; patients showed a moderate-risk profile with a median logistic EuroSCORE II of 7.8 (IQR of 3.8–32.0) %. The implantation of the Perceval S prosthesis was technically successful in all patients. The mean cardiopulmonary bypass time was 103.3 ± 50.0 min, and the cross-clamp time was 69.1 ± 38.8 min. No patients required a permanent pacemaker implantation. The postoperative gradient was 7.3 ± 2.4 mmHg, and no cases of paravalvular leakage were observed. There was one case of intraprocedural death, while the thirty-day mortality was 11%. Conclusions: Sutureless bioprosthetic valves tend to simplify the surgical procedure of a redo AVR. By maximizing the effective orifice area, sutureless valves may present an important advantage, being a safe and effective alternative not only to traditional surgical prostheses but also to transcatheter valve-in-valve approaches in select cases. [ABSTRACT FROM AUTHOR] more...

BackgroundTranscatheter mitral valve replacement (TMVR) has emerged as an alternative to redo surgery. TMVR compared with redo surgical mitral valve replacement (SMVR) in patients with mitral prosthesis failure remains limited. In this study, we performed a meta-analysis to assess the outcomes of TMVR (including valve-in-valve and valve-in-ring) versus redo surgery for mitral prosthesis failure.MethodsWe comprehensively searched the PubMed, Embase, and Cochrane library databases according to predetermined inclusion and exclusion criteria, and then we extracted data. We compared the outcomes of TMVR and redo SMVR for mitral prosthesis failure in terms of the in-hospital mortality, stroke, renal dysfunction, vascular complication, pacemaker implantation, exploration for bleeding, paravalvular leak, mean mitral valve gradient, 30-day mortality, and 1-year mortality.ResultsNine retrospective cohort studies and a total of 3,038 patients were included in this analysis. Compared with redo SMVR for mitral prosthesis failure, TMVR was associated with lower in-hospital mortality [odds ratios (OR): 0.44; 95% confidence interval (CI): 0.30–0.64; P < 0.001], stroke (OR: 0.44; 95% CI: 0.29–0.67; P = 0.0001), renal dysfunction (OR: 0.52; 95% CI: 0.37–0.75; P = 0.0003), vascular complication (OR: 0.58; 95% CI: 0.43–0.78; P = 0.004), pacemaker implantation (OR: 0.23; 95% CI: 0.15–0.36; P < 0.00001), and exploration for bleeding (OR: 0.24; 95% CI: 0.06–0.96; P = 0.04). Conversely, redo SMVR had lower paravalvular leak (OR: 22.12; 95% CI: 2.81–174.16; P = 0.003). There was no difference in mean mitral valve gradient (MD: 0.04; 95% CI: −0.47 to 0.55; P = 0.87), 30-day mortality (OR: 0.65; 95% CI: 0.36–1.17; P = 0.15), and 1-year mortality (OR: 0.96; 95% CI: 0.63–1.45; P = 0.84).ConclusionIn patients with mitral prosthesis failure, TMVR is associated with lower in-hospital mortality and lower occurrence of postoperative complications, except for paravalvular leak. TMVR offers a viable alternative to the conventional redo surgery in selected patients. more...

Fungal endocarditis is associated with high surgical mortality rates. Advanced expertise is required for surgical treatment of this serious condition. In the present report, we describe the homograft replacement in a beating heart during re-re-re-re-do in a 29-year-old female patient with fungal endocarditis. The previous operations included Fallot correction at the age of 1 year, Contegra graft implantation in the right ventricular outflow tract (RVOT) due to severe pulmonary insufficiency, homograft implantation in pulmonary position due to Contegra endocarditis, and on-pump pericardial defect closure after homograft injury during sternal rewiring following wound infection. more...

Background: "valve‐in‐valve" TAVR (VIV‐TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long‐term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3‐years follow‐up. Methods: A total of 77 patients underwent VIV‐TAVR for failing aortic bioprosthesis during a 7‐years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4 ± 5.8 years and a logistic EuroSCORE of 30.8 ± 15.7%. The Society of Thoracic Surgeons‐PROM averaged 5.79 ± 2.63%. Clinical results and hemodynamic outcomes are reported for 30‐days, 1‐, 2‐, and 3‐years. Completeness of follow‐up was 100% with 44 patients at risk after 3‐years. Follow‐up ranged up to 7.1 years. Results: Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1 ± 2.3 mm and true‐ID of 20.4 ± 2.6 mm. A true‐ID ≤21 mm had 58.4% of the patients. Self‐expanding valves were implanted in 68.8% (mean labeled size 24.1 ± 1.8 mm) and balloon‐expanded in 31.2% (mean size 24.1 ± 1.8 mm). No patient died intraoperatively. Hospital mortality was 1.3% and three‐years survival 57.1%. All patients experienced an initial significant dPmean‐reduction to 16.8 ± 7.1 mmHg. After 3‐years mean dPmean raised to 26.0 ± 12.2 mmHg. This observation was independent from true‐ID or type of transcatheter aortic valve replacement (TAVR)‐prosthesis. Patients with a true‐ID ≤21 mm had a higher initial (18.3 ± 5.3 vs. 14.9 ± 7.1 mmHg; p =.005) and dPmean after 1‐year (29.2 ± 8.2 vs. 13.0 ± 6.7 mmHg; p =.004). There were no significant differences in survival. Conclusions: VIV‐TAVR is safe and effective in the early period. In surgical valves with a true‐ID ≤21 mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true‐IDs showed steadily increasing transvalvular gradients. This raises concern about durability. [ABSTRACT FROM AUTHOR] more...

(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb®. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb® were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb® (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, p = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group (p = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb® hemoadsorption in complex cardiac surgery and a trend of lower mortality. [ABSTRACT FROM AUTHOR] more...

Minimally invasive mitral valve surgery (MIMVS) has become the standard approach for mitral valve pathology in many centres. The anterolateral mini thoracotomy access is beneficial in reoperative surgery by avoiding repeat sternotomy associated risks. The aim of this study is to analyse the safety of this technique. All patients undergoing reoperative MIMVS between 2008 and 2019 were studied retrospectively. Primary endpoint was 30-day major complications and mortality; secondary outcome was long term survival, reoperation rate and rate of more than moderate recurrent regurgitation. 146 Patients underwent reoperative MIMVS with a mean age of 68 ± 8 years. The composite outcome of 30-day major complication and mortality was 29.5%. 30-Day mortality was 6.2% and stroke rate 3.4%. Survival for the whole cohort was 89.7 ± 2.5% at 1-year, 71.6 ± 4.3% at 5 year and 50.9 ± 5.9% at 8-year follow up. Cox regression analysis revealed reduced left ventricular function (HR 2.8; 95%CI 1.5 - 5.0), GFR < 60 (HR 2.1; 95%CI 1.2 - 3.7) and active endocarditis (HR 6.4; 95%CI 2.7 - 15.4) as variables associated with reduced long-term survival. The cumulative incidence of re-operation after mitral valve replacement was 11.3 ± 3.2% at 5-year and for repair 16.2 ± 7.5% at 5-year. The cumulative incidence of more than moderate recurrent regurgitation after mitral valve repair was 25.4 ± 9.0% at 3-year. Minimally invasive access in reoperative mitral valve surgery in the current study showed similar 30-day mortality and stroke rate compared to repeat sternotomy results reported in literature. [ABSTRACT FROM AUTHOR] more...

Objective: Treatment of aortic arch pathologies in redo cases is technically challenging. In this study, we assessed early and mid-term outcomes of total endovascular arch repair combined with a new method of in situ laser fenestration. Methods: Between January 2018 and March 2019, five patients with a history of cardiovascular surgery underwent in situ laser fenestration procedures using the "squid capture technique" for aortic arch pathologies with dissection. All patients were followed up regularly and imaging examinations were performed. The technical success, procedural complications, as well as the early and mid-term mortality and morbidity rates were evaluated. Results: All patients survived the operation and fenestration was technically successful in all of the patients. There was no in-hospital mortality. No patients developed major complications, such as peri-operative strokes, transient ischemic attacks, or spinal cord ischemia. The 11–22 months follow-up (mean, 17 months) was completed by all patients. No endoleaks were discovered; false lumen thromboses and subsequent positive remodeling of the aorta were demonstrated and all in situ laser-fenestrated arteries were patent. Conclusions: In situ laser fenestration combined with "squid capture technique" was shown to may be an effective and safe option for reconstruction of aortic arch during thoracic endovascular aortic repair. In situ laser fenestration combined with "squid capture technology" was shown to be an effective treatment option for patients with prior history of cardiovascular surgery and who are at high risk for redo open operations. [ABSTRACT FROM AUTHOR] more...

Background/Aim: Parallel to the developments in congenital heart surgery, the number of children undergoing resternotomy (redo) heart surgery is increasing. In this specific group of patients, postoperative pneumothorax (PTX) and atelectasis are preventable respiratory complications. However, in the literature, pediatric data are still limited. In this study, we draw attention to the frequency and importance of PTX, a post-operative respiratory complication in redo patients. We investigate the necessity for routine chest X-rays to detect PTX following chest tube removal after closed or open-heart operations for congenital heart disease. Methods? A total of 554 consecutive pediatric patients who underwent cardiac surgery were analyzed. The study was designed as a retrospective cohort study. The patient's demographic data, clinical characteristics with chest tube removal, and pathologies detected by chest X-ray were recorded. Patients were divided into non-redo and redo groups or subgroups. Patients who developed PTX (n = 24) were divided into subgroups: asymptomatic or symptomatic and large or small. Data analysis and statistical comparison between the groups were performed with independent-samples t-test or Mann-Whitney U test. Results? In 24 (4.3%) of the 554 patients included in the study, PTX was detected in the post-operative evaluation after chest tube removal. Of the PTX cases, 15 (62.5%) were small, and nine (37.5%) were large. Ten (41.6%) patients were symptomatic, while nine patients had large PTX, and one patient with small PTX was identified. There were significantly more cases of large PTX in redo cases than in non-redo cases (P = 0.038). PTX was significantly more symptomatic in redo patients than non-redo patients (P = 0.031). Conclusion? In patients undergoing cardiac surgery for the first time, a detailed clinical assessment reduces the likelihood of post-procedure PTX and makes routine chest X-ray imaging unnecessary. Conversely, clinical follow-up of these patients in terms of PTX should be essential for possible complications. However, clinical signs of late PTX development in the first 24-48 h after chest tube removal in patients undergoing redo cardiac surgery should be followed carefully by the clinician, and chest X-ray imaging should be routinely performed. [ABSTRACT FROM AUTHOR] more...

Awake craniotomy is used for addressing lesions adjacent to eloquent brain regions to minimize damage to neurological functions, and to expedite postoperative recovery. Redo (i.e., repeat) awake surgery is not common, but always an option, especially for recurrent tumors. This study investigated the tolerability of redo awake surgery in terms of surgical characteristics and postoperative clinical course. Single-institution cohort study of 607 awake craniotomies by 1 surgeon at Toronto Western Hospital, 2006–2018. Out of 607 surgeries, 501 surgeries were first-time, and 106 surgeries were redo. Between the 2 groups, surgery time was longer in redo cases than first-time cases and the rate of reoperation was higher in the former. Matched propensity cohort analysis included 104 cases each, based on adjustments for age, sex, tumor location, malignancy, and preoperative performance status. This revealed differences again in surgery time (128.0 vs. 111.9 minutes, P = 0.0004) and the reoperation rate (7.4 vs. 1.0%, P = 0.03). The causes of reoperation were infection (3 wound infection and 3 brain abscess) and wound dehiscence (n = 1). There was no significant difference in the length of hospital stay, the rates of postoperative hemorrhage, new postoperative neurological deficits, home discharge, or readmission. Although redo surgery might increase the surgery time and the risk of reoperation due to postoperative infection, it was found to be well tolerated in other aspects overall. With extra care to infection and wound healing, redo awake surgery is a viable option to patients with the same surgical indication as for first-time surgery. [ABSTRACT FROM AUTHOR] more...

Introduction: As the experience with robot-assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. Methods: Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication was defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, and perioperative and postoperative outcomes are reported. Results: Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median R.E.N.A.L. score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively because of bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Estimated glomerular filtration rate preservation was 78.7% at discharge and 90.8% at 1-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only 1 patient had local progression (1.4%). Conclusion: In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence. [ABSTRACT FROM AUTHOR] more...

About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero pelvic junction obstruction (UPJO) making it an uncommon operation even in large volume centers. In this MA we have compared the outcomes of open (OP), laparoscopic (LP) and robot assisted LP (RALP) approaches in managing recurrent UPJO. Pubmed/Index medicus etc. were searched for re-do pyeloplasty (Open OR Laparoscopic OR Robot-assisted) AND (Redo OR Reoperative OR failed) AND (child OR pediatric OR paediatric), for articles published between 2001 and 2021. Duplicate publications were identified and removed. Articles with grossly incomplete data and errors in reporting were excluded, as were articles reporting <5 cases. The systematic review was carried out according to PRISMA guidelines and meta-analysis of proportions was carried out using MetaXL 5.3. A total of 18 articles on re-do pyeloplasty were included in the analysis. In total, there were 87, 77 and 123 redo pyeloplasties in OP, LP and RALP groups respectively. The I2 statistics for OP, LP and RALP showed low heterogeneity with I2 of 24%, 0% and 20% respectively. LFK index was 0.88, 0.30 and 1.62 for OP, LP and RALP respectively, suggesting no or minor publication bias. The overall success rates of OP, LP and RALP re-do pyeloplasty were 93.1% (95% CI 86–98), 92.1% (95% CI 83–96) and 89.4% (95% CI 83–96) respectively (summary table). The success rate between the techniques was not significantly different, with p values (x2) of 1 (OP vs LP), 0.5 (OP vs RALP) and 0.6 (LP vs RALP). Overall, redo RALP took significantly longer time than redo LP (p < 0.001, Fisher's). Overall, RALP had significantly shorter hospital stay than LP (p < 0.001) and LP had significantly shorter hospital stay than OP (p < 0.001). The complication rate was 9% in OP and LP and 16% in RALP, the difference being not statistically significant (p value 1, 0.26 and 0.27 for OP vs LP, OP vs RALP and LP vs RALP respectively, x2). In conclusion MIS techniques (LP and RALP) seem to be good alternatives to OP for redo pyeloplasty in children, with comparable success and complications. Redo RALP had longer duration of surgery but shorter hospital stay than redo LP. With comparable success & complication rate between RALP and LP, this MA could not favor one over the other for redo pyeloplasty. [ABSTRACT FROM AUTHOR] more...

Introduction: Over the last two decades, a progressive increase in failure rate of bariatric surgery (BS) has occurred in conjunction with an exponential increase in BS worldwide. Bariatric surgeons are confronted with challenging situations in patients with a complex bariatric history. In this study, we aim to evaluate the feasibility and outcomes of revisional BS in patients with at least two or more previous bariatric procedures. Methods: Data were retrospectively retrieved from a prospectively held database of bariatric procedures performed at our tertiary referral bariatric center and included procedures done from February 2013 up to April 2019 by a single center. Results: Thirty patients underwent a third bariatric procedure. The median age was 40 (18–57) and 54 (27–69) years at the time of the first and the last procedures, respectively. Laparoscopic adjustable gastric banding was the first procedure in 26 patients. The complication rate was 33%; no patient required additional surgery because of postoperative complications. A total weight loss of 29.6% and an excess loss of 53.4% were obtained at a mean follow-up of 61 months after the last redo bariatric procedure. Conclusion: This study indicates that redo BS either conversional or revisional is feasible and effective in patients with a complex bariatric history including two or more previous procedures. Careful patients' selection is mandatory and extensive information should be given on the increased risk of postoperative complications. [ABSTRACT FROM AUTHOR] more...

Introduction: Isolated redo‐mitral valve replacement (iMVR) is underreported and often mixed up with endocarditis in the present literature. The present study compares first with redo iMVR in noninfective mitral disease. Patients and Methods: A total of 3821 mitral valve procedures were analyzed. The study was restricted to isolated and noninfective mitral valve replacements done by sternotomy. Finally, 402 patients are included, consisting of 102 redo‐ and 300 first surgeries. The mean patient's age was 65.9 ± 10.4 years; the mean EuroSCORE II was 3.0 ± 2.2%. Median follow‐up was 221 days, ranging up to 9.9 years with a total of 367 patient‐years. Results: Redo's had higher EuroSCORE II (5.1 ± 2.9% vs. 2.3 ± 1.4%; p <.01), more atrial fibrillation (31.1% vs. 46.1%; p =.01), chronic obstructive pulmonary disease (7.3% vs. 17.6%; p =.05), coronary artery disease (7.3% vs. 17.6%; p =.03) and more frequently reduced ejection fraction < 30% (3.0% vs. 11.8%; p =.02). Main outcomes showed comparable 30‐days mortality (first: 4.1%, redo: 6.9%; p =.813). Postoperative morbidity of the redo's was associated with increased postoperative bleeding (p <.01) resulting in increased transfusions of packed red blood cells and fresh frozen plasma (each p <.01), more re‐explorations (p <.01) and longer primary intensive care unit stay (p <.01). Postoperative occurrence of stroke, respiratory or renal failure, and myocardial infarction as well as hospital stay differed not significantly. Estimated 5‐years survival was 65.5 ± 12.3% for all patients with no significant differences between the groups. Multivariate logistic regression respiratory failure as relevant for hospital (odds ratio [OR]: 12.3 [1.1–158]; p =.029) and stroke (OR: 4.8 [1.1–12.3]; p =.021) as relevant for long‐term mortality. Conclusion: iMVR for noninfective reasons is infrequent and rare. Compared to primary surgery, redo's suffer mainly from bleeding‐associated morbidity. This does not translate into prolonged hospital stay or inferior immediate or long‐term outcomes. Redo mitral valve replacement can be performed at no significantly increased surgical risk compared with first surgery and the results are particularly not limited by the surgery itself. [ABSTRACT FROM AUTHOR] more...

Objectives: To evaluate and compare the effects of redo percutaneous mitral valvuloplasty with initial percutaneous mitral valvuloplasty (PMV) in mitral restenosis (MR) and de novo mitral stenosis (MS) patients, respectively. Methods: A retrospective study was conducted at the cardiology department of Ch. Pervaiz Elahi Institute of Cardiology Multan for the period of one year from 6th July 2020 to 6th July 2021. A total of 50 patients were recruited in the study. Out of them, 20 de novo MS patients were placed in one group, while 30 patients with mitral restenosis, after successful initial percutaneous mitral valvuloplasty, were placed in another group. Ante grade trans-septal approach was adopted to perform percutaneous mitral valvuloplasty. The procedure was considered successful in achieving a 50% increase in the area of the mitral valve, without any major complication. Results: Procedural success in first PMV patients was more (18 patients; 90.0%) than in redo PMV patients (26 patients; 86.6%) (Non-significant). The patients in both groups didn’t differ significantly in terms of MVA after the procedure, the increase of MVA, the average difference in blood pressure across the mitral valve, and the complications experienced after the complete procedure. However, the final mitral valve area was negatively correlated with the initial area in both groups. Conclusion: Redo PMV for MR when performed after successful initial PMV is effective, has considerable rate of procedural success, which is achieved with a complication rate less as compared to initial PMV for de novo mitral stenosis. [ABSTRACT FROM AUTHOR] more...

Background In spite of improved survival of first-time mitral valve replacement (MVR), operative mortality associated with redo-mitral valve surgery is still higher than that of the primary operation. Consequently, more patients require redo-MVR, and studies investigating the operative outcome with current techniques and prostheses are thus needed. Patients and methods This is a nonrandomized prospective study that included 83 patients who underwent redo-MVR with either bioprosthetic or mechanical valves between March 2014 and December 2017 at National Heart Institute. Recorded data were analyzed using the statistical package for social sciences, version 23.0 (IBM SPSS). All preoperative and operative data were analyzed in univariate model to identify predictors of operative mortality and prolonged hospital stay (more than 10 days). Results A total of 46 (55.4%) females and 37 (44.5%) males constituted the study population. Overall, 16 (19.3%) patients in this study had ejection fraction below 50%. Indications for reoperation included endocarditis in 38 (45.8%) patients, para-prosthetic leak in 23 (27.7%) patients, structural valve degeneration in 12 (14.4%) patients, and prosthetic valve thrombosis in 10 (12.0%) patients. In-hospital mortality was 11 (13.3%) patients. Mean hospital stay was 13.68 ± 3.87 days (range, 7–22 days). Univariate analysis showed that operative mortality was associated with the left ventricular ejection fraction less than 50% (P = 0.018), structural valve degeneration (P = 0.027), and total operative time in hours (P < 0.001). Similarly, univariate analysis for prolonged hospital stay showed a significant association between it and higher preoperative EuroSCORE (P = 0.003). Conclusion Repeat MVR can be done safely and with a good overall clinical outcome. Although left ventricular ejection fraction less than 50%, structural valve degeneration, and total operative time in hours are associated with early hospital mortality, higher preoperative EuroSCORE is associated with prolonged hospital stay. more...

Background: Redo fundoplication (RF) and Roux-en-Y diversion (RNY) are both accepted surgical treatments after failed fundoplication. However, due to higher reported morbidity, RNY is more commonly performed only after several surgical failures. In our experience, RNY at an earlier point of the disease progression seems to be related with better outcomes. The aim of this study was to investigate this aspect by comparing the results between RF and RNY performed by a single surgeon over 3 years at our institution.Methods: A prospectively maintained database was reviewed to identify patients who underwent RF or RNY at our institution between 2016 and 2019 by a single surgeon (author SKM). Patients with previous bariatric surgery were excluded.Results: Of 43 patients, 28 underwent RF and 15 underwent RNY (mean body mass index 28.6 and 32.7 kg/m2, respectively, p = 0.01). The number of previous antireflux surgeries for the RF and RNY groups was 1 (82% vs 80%, p > 0.99), 2 (18% vs 7%, p = 0.4), and more than 2 (0% vs 13%, p = 0.1). RNY took longer than RF (median, 165 vs 137 min, p = 0.02), but both groups had a median estimated blood loss of 50 ml (p = 0.82). There was no difference in intraoperative complications (25% vs 20% for RF and RYN, respectively, p > 0.99). Postoperative complications were more common in the RF than in the RYN group (21% vs 7%, p = 0.39). Median hospital stay was 3 days for both groups (p = 0.78). At short-term follow-up, the mean quality of life score was similar for the RF and RYN groups (11.5 vs 12.2, p = 0.8).Conclusions: RNY diversion, if performed by experienced hands and at an earlier point of disease progression, has comparable perioperative morbidity to RF and should be considered as a feasible and safe option for definitive treatment of failed antireflux surgery. [ABSTRACT FROM AUTHOR] more...

Björk-Shiley tilting disc prosthesis was the first tilting disc prosthesis to be used worldwide on a large-scale basis. Herein, we report a case of a 67-year-old male presenting with severe prosthetic valvular dysfunction. He had undergone mitral valve replacement with Björk-Shiley valve at some other center in 1987. The surgical challenge was to replace that with an adequately sized prosthesis. To achieve that, we removed all the previously preserved posterior cusp and then reconstructed the sub-valvular apparatus. The patient had a smooth post-operative recovery. This case report highlights the longest reported survival of a Björk-Shiley mitral valve and specific challenges faced during such redo cases. [ABSTRACT FROM AUTHOR] more...

Background: We have entered an era of renewed interest in novel approaches to surgical intervention and minimally invasive and transcatheter technique. With an aging population, isolated tricuspid valve regurgitation incidence is rising; however, referral for surgical intervention remains low. Aims: We undertook this retrospective review to assess outcomes and challenges associated with tricuspid valve intervention. Methods: A comprehensive retrospective review of all patients undergoing tricuspid valve intervention in our institution between 2004 and 2018 was carried out. Results: A total of 259 patients who underwent a tricuspid intervention between 2004 and 2018 were identified. Of those, 229 underwent a repair and 30 underwent a replacement. Median survival for repair was 3124 days, and replacement was 2294 days. In-patient mortality was 12% for those undergoing repair and 7% for the replacement patients. Of those undergoing redo tricuspid valve intervention, eight patients (61.5%) were alive at most recent follow-up. Eight patients required intraoperative pacemakers, 2 required postoperative pacemakers. Of those who had intraoperative epicardial pacing systems placed, 5 of the 8 remained pacing dependent on most recent follow up. Conclusion: Beyond technical challenges, decision making regarding pacemaker requirement requires further exploration. Redo tricuspid valve surgery carries a significant mortality risk and consideration should be given to earlier intervention in this context. [ABSTRACT FROM AUTHOR] more...

Abstract Background Redo isolated tricuspid valve surgery is associated with a high morbidity and mortality, and its optimal timing remains controversial. Hence, here we reviewed the early and midterm results of simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery in patients at high risk. Methods A total of 32 consecutive patients underwent a redo isolated tricuspid valve surgery using minimally invasive, beating-heart technique through a right lateral thoracotomy in our center between June 2016 and April 2020. The mean age of patients was 57.4 ± 8.3 years, and 18 patients (56.3%) were women. The mean preoperative EuroSCORE was 7.8 ± 1.4 (range: 6–11). Follow-up was 87.1% complete, with a mean duration of 26.3 ± 12.3 months. Results Both in-hospital and 30-day mortalities were 3.1%. Tricuspid valve replacement with bioprosthesis was performed in 30 patients (93.8%), and the remaining two patients (6.2%) underwent tricuspid repair (annuloplasty and leaflet reconstruction). The mean cardiopulmonary bypass time was 81.5 ± 29.0 min. The overall in-hospital duration and intensive care unit (ICU) times were 13.6 ± 7.6 days and 4.1 ± 2.8 days, respectively. Postoperative complications included prolonged ventilation in six patients (18.8%), acute kidney injury in three patients (9.4%), and neurologic event, wound infection, or permanent third-degree atrioventricular block, in one patient (3.1%) each. A total of 96.9% patients were discharged uneventfully. Four patients were lost to follow-up; there were no midterm deaths in patients who were followed up. Conclusions Simplified, minimally invasive, beating-heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent. more...

Background and Objectives: Sutureless aortic valve prostheses have presented favorable hemodynamic performance while facilitating minimally invasive access approaches. As the population ages, the number of patients at risk for aortic valve reoperation constantly increases. The aim of the present study is to present our single-center experience in sutureless aortic valve replacement (SU-AVR) in reoperations. Materials and Methods: The data of 18 consecutive patients who underwent SU-AVR in a reoperation between May 2020 and January 2023 were retrospectively analyzed. Results: The mean age of the patients was 67.9 ± 11.1 years; patients showed a moderate-risk profile with a median logistic EuroSCORE II of 7.8 (IQR of 3.8–32.0) %. The implantation of the Perceval S prosthesis was technically successful in all patients. The mean cardiopulmonary bypass time was 103.3 ± 50.0 min, and the cross-clamp time was 69.1 ± 38.8 min. No patients required a permanent pacemaker implantation. The postoperative gradient was 7.3 ± 2.4 mmHg, and no cases of paravalvular leakage were observed. There was one case of intraprocedural death, while the thirty-day mortality was 11%. Conclusions: Sutureless bioprosthetic valves tend to simplify the surgical procedure of a redo AVR. By maximizing the effective orifice area, sutureless valves may present an important advantage, being a safe and effective alternative not only to traditional surgical prostheses but also to transcatheter valve-in-valve approaches in select cases. more...

We report a 75-year-old female with a history of two heart operations: aortic valve replacement (St. Jude Medical TM 21 mm) at the age of 44 years for severe rheumatic aortic stenosis and mitral valve replacement (Carbomedics TM 29 mm) at the age of 51 years for rheumatic mitral regurgitation. Decades later, she presented with exertional dyspnea. Echocardiography revealed aortic stenosis with an effective orifice area of 0.79 cm². Coronary angiography showed #6 75% stenosis and a limited mechanical valve opening. After a thorough discussion, the patient agreed to undergo redo surgery. The surgery involved re-median sternotomy, left internal thoracic artery (LITA) harvesting, pannus removal, and replacement of the aortic valve with a 20 mm ATS advanced performance (AP) prosthesis (ATS Medical, Minneapolis, MN) in a supra-annular position. The LITA-left anterior descending (LAD) bypass was completed, and the patient was weaned from the cardiopulmonary bypass without complications. Postoperatively, the right phrenic nerve paralysis caused transient respiratory challenges requiring tracheotomy and prolonged ventilation. Rehabilitation improved diaphragmatic function and respiratory independence. At six months, the right phrenic nerve function had recovered, and the patient resumed walking independently with a cane. Two years postoperatively, the patient remained ambulatory and attended independent outpatient follow-ups. This report highlights the potential for gradual recovery from phrenic nerve paralysis following open heart surgery, emphasizing the importance of long-term multidisciplinary care., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nakajima et al.) more...

BackgroundTricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for surgical treatment. In current years, minimally invasive isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation.MethodsThirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4 ± 8.5 years. Follow-up was 100% complete with a mean follow-up time of 17.2 ± 9.5 months.ResultsBoth the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up (p < 0.001). The grade of TR had decreased before discharge (p < 0.001) and during the follow-up (p < 0.001) compared with the preoperative level although severe TR was recurrent in one patient.ConclusionsMinimally invasive isolated tricuspid valve repair has acceptable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible. more...

Purpose: Catheter ablation for atrial fibrillation (AF) is a standard procedure for maintaining sinus rhythm. The aim of this study was to evaluate treatment success and its predictors and to provide quality control data on complications and redo operations in a centre with an initially a low but currently high annual volume. Methods: Data on patients (n = 1,253) treated with catheter ablation for AF in Tays Heart Hospital between January 2010 and May 2018 was evaluated (n = 1178 ablation-naïve patients and n = 1514 AF ablations). Comprehensive data on patient characteristics, treatment results, redo operations and complications were collected. Treatment success (maintenance of sinus rhythm at 1 year) was evaluated among patients residing within the hospital district (45% of the entire study population). Results: Treatment success was observed in approximately 62.9% of the ablation-naïve patients. Preoperative predictors of treatment success were paroxysmal AF type, previous use of antiarrhythmic drugs, left atrium diameter and age. The experience at the centre did not associate with the 1-year outcome. A relapse during the first 3-month blanking period was associated with a nine-fold risk of failure at 1 year (unadjusted OR 9.1, 95% CI 5.5–15.1, p < 0.001). The major complication rate was 4.5% (68/1514) with no deaths. Ten percent of the patients needed a redo procedure within the first year. Conclusions: Patient-related factors are the most significant predictors of treatment success. A relapse during a 3-month blanking period is associated with a very high risk of failure at 1 year. [ABSTRACT FROM AUTHOR] more...

Abstract A 56‐year‐old woman entered the emergency department due to worsening dyspnea. Severe mitral regurgitation and pulmonary artery dilation with flow compatible with fistula were observed by transthoracic and transesophageal echocardiography. The patient had history of an ALCAPA (anomalous left coronary artery from pulmonary artery) syndrome having undergone coronary artery bypass grafting (saphenous venous graft to left anterior descending artery) 30 years before. Coronary angiography and computed tomography revealed patency of the graft, with the dilated vein running across the front of the ascending aorta and being responsible for the perfusion of the left anterior descending artery and circumflex artery. We resent this case for discussion of which surgical strategy/options are available in order to treat the mitral valve and avoid injuring the patent graft. more...

Aim: To review our surgical experience and outcome of redo pull-through for various postoperative complications of Hirschsprung's disease. Methods: A retrospective study was performed on children who underwent redo pull-through from 2016 to 2019. Operative methods and functional outcomes were compared between those with anastomotic complications (stricture and fistula, n = 12) and patients without anastomotic complications (n = 24) such as residual aganglionosis/transition zone, twisted pull-through and tight soave cuff. Result: 36 Patients (29 male and 7 female) were included with median age 6 (0.1–54) months at primary and 36 (9–144) months at redo pull-through. A transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) pull-through with laparoscopic (n = 10, 27.8%) or laparotomy (n = 26, 72.2%) assisted techniques were performed for all patients during redo procedure. Patients with anastomotic complications had lower incidence of successful laparoscopic pull-through (0%), higher postoperative complications (25%) after redo surgery, but similar functional outcomes compared to those without anastomotic complications (41.6% underwent laparoscopic surgery, 4.2% complications). Patients with partial colectomy had significantly less soiling (36.4%) and enterocolitis (0%) compared to those with subtotal/total colectomy (79.2% soiling and 58.3% enterocolitis). Conclusion: TRM-PIAS with/without laparoscopic-assisted redo pull-through was effective in treating various complications after primary pull-through. The functional outcome is strongly associated with the length of residual colon after redo pull-though. [ABSTRACT FROM AUTHOR] more...

Objective: To describe patient characteristics and post-operative outcomes, including early and late mortality, defined by death within 30 days and after 30 days post-surgery, respectively, as well as 20-year survival after isolated reoperative tricuspid surgery. Methods: We retrospectively analyzed 169 patients who underwent isolated reoperative tricuspid valve surgery at our institution (between 1997 and 2000) and describe post-surgical outcomes including intraoperative, early and late mortality. All patients included completed 21 years of follow-up. Results: The majority of our patients were females 147 (87%) with the mean age of 45.9 ± 12.9 years. The mean body mass index (BMI, kg/m²) was 27.4 ± 6.0. Previous cardiac surgeries included tricuspid valve surgeries in 169 (100%) patients, with bioprosthetic valves, mechanical valves, annual rings and tricuspid repair surgeries utilized in 37 (21.9%), 21 (12.4%), 38 (22.4%) and 73 (43.2%) patients, respectively. The indication for previous tricuspid surgery was rheumatic heart disease in 154 (91.5%) patients. The most common cause of reoperative valvular surgery was tricuspid regurgitation (TR) in 139 (82.2%), with 66% of patients having severe TR. Other reasons for reoperative surgery included tricuspid stenosis 22 (13%) and dehiscence 8 (4.7%). For the redo surgery, 125 (74%) patients underwent Tricuspid Valve Replacement (TVR), 90 (53%) of whom received bioprosthetic valves while 35 (21%) received mechanical valves. Forty-four patients (26%) underwent Tricuspid Valve Repair. Mortality within 30 days of surgery was 11.3% (20 patients) and 11.4% after 30 days, with 20 years survival being about 80%. Conclusions: Based on our experience, reoperation for failed isolated tricuspid valve replacement or repair was associated with reasonable mortality and good survival rate over long period of time. [ABSTRACT FROM AUTHOR] more...

Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic gall stone disease. Laparoscopic cholecystectomy is done worldwide by general surgeons, but difficult cases remain challenging even to experts in laparoscopic surgery. Redo-cholecystectomy is done owing to either interval cholecystectomy after first surgery or stone in cystic duct stump or remnant gall bladder. The most important investigation done for the patients is magnetic resonance cholangiogram. Redo-surgery is applicable to be done laparoscopic. Patients and methods A retrospective study was conducted on 11 patients whom underwent to cholecystectomy either open or laparoscopic, where one case could undergo cholecystostomy by Foley’s catheter and second one could not reach the gall bladder, and nine cases could undergo laparoscopic (four cases postpone from the start and five cases have remnant of gall bladder or retained stone in it). Clinical examination, laboratory, and radiological evaluation was done. All cases of redo-surgery were by laparoscopy. Results One case needed to convert to open surgery. Time of surgery ranged from 1 to 3 h. There is no bile leakage or common bile duct injury. There were two cases of intraoperative bleeding and one case with postoperative bleeding. Postoperative stay in hospital was 1–2 days, except a case that was converted to open, which had 3 days of hospital stay. Conclusion Redo-laparoscopic cholecystectomy is applicable and safe but needs experience in laparoscopic skills. [ABSTRACT FROM AUTHOR] more...

The aim of the present study was to describe a bicaval endovascular occlusion technique in minimally invasive tricuspid valve (TV) surgery in patients with previous cardiac surgery. Case series. Single tertiary university center. The study comprised ten patients. Endovascular occlusion of vena cavae for minimally invasive TV redo surgery. Between 2008 and 2017, ten patients with previous cardiac surgery underwent TV minimally invasive surgery (repair or replacement; isolated or with concomitant procedures) using the Coda balloon catheter (Cook Medical, Bloomington, IN) to occlude both vena cavae. Data were collected retrospectively from electronic medical records. Superior and inferior vena cava occlusion with Coda balloon catheters was successful with no complications. The drainage of the vena cavae was optimal with excellent surgical exposure. Cardiopulmonary bypass time was 131 ± 119 minutes, with 30% of patients undergoing aortic clamping (two with a Chitwood clamp, one with an endoaortic balloon). Intensive care unit length of stay was 3.9 ± 2.7 days, and the in-hospital mortality rate was 30%. Bicaval endovascular occlusion of vena cavae is a feasible and effective technique in patients with previous cardiac surgery who are undergoing a minimally invasive TV procedure. The high mortality rate is associated with the inherent risk of a redo surgery involving the TV. [ABSTRACT FROM AUTHOR] more...

Background In spite of improved survival of first-time mitral valve replacement (MVR), operative mortality associated with redo-mitral valve surgery is still higher than that of the primary operation. Consequently, more patients require redo-MVR, and studies investigating the operative outcome with current techniques and prostheses are thus needed. Patients and methods This is a nonrandomized prospective study that included 83 patients who underwent redo-MVR with either bioprosthetic or mechanical valves between March 2014 and December 2017 at National Heart Institute. Recorded data were analyzed using the statistical package for social sciences, version 23.0 (IBM SPSS). All preoperative and operative data were analyzed in univariate model to identify predictors of operative mortality and prolonged hospital stay (more than 10 days). Results A total of 46 (55.4%) females and 37 (44.5%) males constituted the study population. Overall, 16 (19.3%) patients in this study had ejection fraction below 50%. Indications for reoperation included endocarditis in 38 (45.8%) patients, para-prosthetic leak in 23 (27.7%) patients, structural valve degeneration in 12 (14.4%) patients, and prosthetic valve thrombosis in 10 (12.0%) patients. In-hospital mortality was 11 (13.3%) patients. Mean hospital stay was 13.68 ± 3.87 days (range, 7-22 days). Univariate analysis showed that operative mortality was associated with the left ventricular ejection fraction less than 50% (P = 0.018), structural valve degeneration (P = 0.027), and total operative time in hours (P < 0.001). Similarly, univariate analysis for prolonged hospital stay showed a significant association between it and higher preoperative EuroSCORE (P = 0.003). Conclusion Repeat MVR can be done safely and with a good overall clinical outcome. Although left ventricular ejection fraction less than 50%, structural valve degeneration, and total operative time in hours are associated with early hospital mortality, higher preoperative EuroSCORE is associated with prolonged hospital stay. [ABSTRACT FROM AUTHOR] more...

Background: The Carpentier‐Edwards Perimount valves have a proven track record in aortic valve replacement: good durability, hemodynamic performance, rates of survival, and low rates of valve‐related complications and prosthesis–patient mismatch. The St. Jude Medical Trifecta is a newer valve that has shown comparable early and midterm outcomes. Studies show reoperation rates of Trifecta are comparable with Perimount valves, with a few recent studies bringing into focus early structural valve deterioration (SVD), and increased midterm SVD in younger patients. Given that midterm data for Trifecta is still sparse, we wanted to confirm the early low reoperation rates of Trifecta persist over time compared with Perimount. Methods: The Maritime Heart Centre Database was searched for AVR between 2011 and 2016, inclusive. The primary endpoint of the study was all‐cause reoperation rate. Results: In total, 711 Perimount and 453 Trifecta implantations were included. The reoperation hazards were determined for age: 0.96 (0.92–0.99; p =.02), female (vs. male): 0.35 (0.08–1.53; p =.16), smoker (vs. nonsmoker): 2.44 (0.85–7.02; p =.1), and Trifecta (vs. Perimount): 2.68 (0.97–7.39; p =.06). Kaplan–Meier survival analysis in subgroups—age <60, age ≥60, male, female, smoker, and nonsmoker—showed Perimount having lower reoperation rates than Trifecta in patients younger than 60 (p =.02) and current smokers (p <.01). Conclusions: The rates of reoperation of Perimount and Trifecta were comparable, with Trifecta showing higher rates in patients younger than 60 years, and current smokers. Continued diligence and further independent reporting of midterm reoperation and SVD rates of the Trifecta, including detailed echocardiographic follow‐up, are needed to confirm these findings. [ABSTRACT FROM AUTHOR] more...