[Report of 108 patients with valvular heart disease who underwent re-operations through repeated median sternotomy incision].

108 patients who underwent redo median sternotomy between January 1975 and April 1988 were studied to determine factors affecting risk of cardiac reoperations. (1) Seventeen of 108 patients died, yielding an overall mortality of 15.7%. (2) Preoperative diagnosis had a significant correlation with mortality, which was higher with prosthetic valve endocarditis (50.0%) than with all other indications for reoperation. (3) Operative mortality was related to pre-reoperation functional class: 8.7% for New York Heart Association (NYHA) class II, 9.8% for class III and 27.8% for class IV. (4) Based on the degree of urgency, elective reoperation had a mortality of 5.4%, while emergency procedures carried a mortality of 61.5%. (5) Cardiac catheterization information was available in 53 patients. The pulmonary artery pressure was higher in the died group. There were no significant differences in pulmonary capillary wedge pressure and cardiac index between the survived and died. (6) Operation time, aortic cross clamp time and pump run were significantly longer in the died than in the survived group. The died had more blood loss during operative procedure. To decrease operative mortality, technical improvement and increased experience were necessary for surgeons. We prefer to free entirely pericardial adhesion to facilitate mobilization and evacuate air, and to make intra-cardiac procedure more easier and safety. Furthermore early reoperation before irreversible deterioration occurs was necessary since myocardial function was found to be a major determinant of surgical results.