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REDO/Complex Heart Surgeries

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REDO/Complex Heart Surgeries Questions & Answers

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Bypass surgery (CABG) is a mechanical solution to a complex bio-chemical problem of the human body known as atherosclerosis. The grafts used to bypass coronary arteries are also susceptible to atherosclerosis, specially the venous grafts. A strict diet and exercise schedule along with regular follow-up to your doctor is needed to prevent graft re-stenosis. The venous grafts tend to close after 8-10 years, in which case the patient again develops symptoms of Angina or breathlessness and require a check angiogram. REDO-bypass surgery can be performed safely in experienced hands and by using multiple arterial grafts (An-OPCAB total arterial bypass) the long term results are improved.

Again, valve replacement surgery is not a curative surgery but a palliative one, we are replacing a diseased valve with an un-natural valve!In case of a mechanical valve there are chances of valve thrombosis (blood clotting) which is a dreaded complication and leads to impairment of valve function needing urgent medical attention. In Valve thrombosis patient may need an urgent REDO-surgery. To prevent valve thrombosis patient are kept on anticoagulant and the PT/INR should be maintained as per the doctor’s advise. A tissue valve tends to degenerate after 12-15 years and a REDO-surgery is needed if its function deteriorates.

The REDO-cardiac surgery does carries a relatively high risk as compared to first surgery. The major risk factors of REDO- surgery are:
1. REDO-sternotomy: The major risk of a REDO-surgery is a REDO- sternotomy, because the heart and major blood vessels are adhered to the sternum due to primary surgery and they are at risk of injury while doing a REDO-sternotomy
2. PERICARDIAL adhesions: Because of a previous operation the pericardium is adhered to the heart muscle & relieving those adhesions is necessary to perform REDO-surgery.
3. There are also more chances of blood loss and transfusions and more ICU & hospital stay as compared to primary surgery.

Yes a REDO surgery can be performed through MICS approach, hence avoiding a REDO-sternotomy and its associated complications.