Are You Facing a Heart Reoperation? What You Need to Know

Thanks to continuing advances in heart surgery and improved life expectancy, many people live long enough to require a second heart operation, commonly called a heart reoperation.

An operation duplicating your first surgery is often successful, but if you’re considering this type of surgery, you need to understand its unique challenges.

What makes a reoperation surgery more challenging?

1. Age, complications

First of all, you’re older than you were when you had your first heart surgery. And you’re possibly dealing with additional medical problems. Depending on how serious your other medical issues are, a reoperation can be more difficult to recover from.

2. Adhesions

Second, you probably have adhesions — which are similar to scar tissue.

These web-like connections between the structures in your chest can develop as a result of the first operation. This may present technical difficulties for your surgeon, especially if they are not experienced in performing reoperations. A preoperative CT scan can be helpful to determine the safety of and strategy for reentering your chest.

3. Progression of your disease

If you had coronary bypass grafting before, your surgeon likely used your best arteries for the first surgery. Now, they must rely on a segment of artery that’s further along the vascular tree.

If you had a valve operation, you may now have disease involving multiple valves.  If you have aortic disease, you may have an aneurysm involving an additional segment of your aorta.  Or you may now have disease involving one of these structures that did not need attention during the previous operation.

These multi-component operations are best handled by a team with experience preparing for and performing these complex operations.

Why would you need heart reoperation surgery?

There are several reasons why you may need a second (or third, fourth or more) heart operation.

1. It’s been awhile since your first surgery

If you had coronary artery bypass, you may find that you need a second surgery later in life because of new disease in your own vessels or disease that has developed in your bypass grafts. How long a coronary artery bypass lasts depends on a number of things, including:

• Type of bypass used (vein or artery).
• Quality of the coronary arteries being bypassed.
• Risk factors (such as smoking, extra weight, high cholesterol, lack of exercise).
• Genetic tendencies.

2. A valve repair or replacement fails

If you had a heart valve repair or replacement, the operation sometimes needs to be repeated. Repairs are typically chosen over replacement because of the prospect for longer durability.

Depending on the reason for the first repair, sometimes the valve itself will still degenerate over time.  Similarly, tissue replacement valves are known to wear out over time (usually in the second decade) and even mechanical valves can develop later problems that may require a reoperation.

For example, the valve might start to leak or allow blood to flow backwards (regurgitate). This impairs your heart function. We can often repair the valve again to achieve the outcomes that we hoped for in the first surgery, or we can replace (or re-replace) the valve.

3. Complications develop

If you develop an infection or other complications from your initial surgery, you may need a second heart surgery. These reoperations are particularly difficult and should be addressed by a team familiar with the safest techniques for successful treatment.

What you need to know before scheduling surgery

Here are a couple of key suggestions if your doctor says you need a heart reoperation:

• Choose an experienced surgeon. Find someone who has done many heart reoperations. This type of procedure is not as common as an initial heart surgery, so it may take you more time to find the best-qualified physician.
• Hospital experience matters, too. Choose a hospital that has a lot of experience with reoperations and has a team of physicians readily available to handle any other medical issues you have.

Patients who have high risk factors or who undergo second procedures do best at high-volume medical centers where the surgical and support teams have a lot of experience. Almost one-third of the heart surgery operations we do are repeat procedures.

If you’re facing a heart reoperation, keep in mind that the safety and success of these surgeries continue to grow, particularly when an experienced surgeon does your surgery at a high-volume center. Take the time to choose your hospital and surgeon carefully for the best outcome.

Contributor: Eric E. Roselli, MD