Impact of timing on outcomes following redo-sternotomy after initial CABG or valvular surgery

Abstract

The optimal timing of reoperation for those who need repeat coronary artery bypass grafting (CABG) and valve surgery is not well established. Early re-entries may be technically challenging due to adhesions and incomplete healing, while delayed interventions may expose patients to progressive cardiac disease. Patients undergoing redo-sternotomy for CABG and valve surgery were identified from the TriNetX database and categorized into three cohorts based on the interval from their initial sternotomy: <1 year, 1–5 years, and > 5 years. Redo-sternotomies performed < 30 days after the initial procedure were excluded, as these typically represent early interventions for acute complications rather than planned reoperations. Two independent propensity score–matched analyses compared < 1 year vs. 1–5 years and 1–5 years vs. > 5 years, with separately matched 1–5 years cohorts for each comparison. Propensity score matching (PSM) was performed based on demographics, comorbidities, prior cardiac procedures, medications, and laboratory parameters including BMI. Primary outcomes included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and emergency department or hospital readmissions. Secondary outcomes included postoperative infection, atrial fibrillation, acute kidney injury, dialysis, cardiogenic shock, respiratory failure, and cerebrovascular events. After PSM in the < 1 year vs. 1–5 years analysis ( N = 305 in each group), redo-sternotomy within 1 year showed no significant differences in mortality, MACCE or readmissions. Combined cerebrovascular events were significantly reduced in the < 1 year group. In the 1–5 years vs. > 5 years analysis ( N = 439 in each group), outcomes were similar between groups, with no significant differences in mortality, MACCE, or readmissions. Atrial fibrillation was significantly higher in the 1–5 years group. All other secondary outcomes, including combined cerebrovascular events, were comparable. Redo-sternotomy within 1 year appears to be equally safe compared to later intervals, with comparable rates of adverse events, including mortality, MACCE, readmissions, postoperative infection, or AKI.