Emergency redo cardiac surgery is associated with a very high mortality rate of 43%, and logistic EuroSCORE may provide the best risk prediction for these complex cases.
Emergency redo cardiac surgery carries high mortality and costs; leaves open the need for prospective validation of risk models and cost-effectiveness strategies.
Emergency redo surgery is rare, but may be required in patients with conditions such as endocarditis, unstable angina and acute aortic dissection. To date there are no published data on the outcome of these difficult patients. Prospective consecutive data were collected from a single institution on 65 patients (51 male) undergoing coronary artery bypass grafts (27), mitral valve replacement or repair (13), aortic valve replacement (7), aortic surgery (13), and other (combined procedures) (5). Indications for surgery were unstable angina (12), endocarditis (11), resuscitation/catheter lab complications (11), torn prosthetic leaflet (6), aortic dissection (4), paraprosthetic leak (2), other (19). Mean ITU stay was 45 h (0-284) and hospital stay was 13.3 days (0-68). There were 14 intra-operative deaths and 14 further in-hospital deaths (overall mortality 43%). Predicted mortality rates were 26% (Parsonnet), 11% (EuroSCORE) and 31% (EuroSCORE logistic). Mean hospital cost per patient was 18,299 euros (or 32,147 euros per hospital survivor). In conclusion, the mortality in these difficult patients is very high, however, often no other treatment option is available. More sophisticated models, such as EuroSCORE logistic, may allow better prediction of risk in very high risk cases.
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Goodwin et al. (2003) studied this question.
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