I checked out the study referenced above and discovered that the data came from a study of mostly Congenital Heart Disease patients under the age of 20, with 80% of the cases between age 3 and 10 years.
I would expect different results when looking at the ADULT population, especially the more 'Elderly". I acknowledge that second surgeries seem to have very good results, approaching the risk levels of first time surgeries, but it is my (non-professional) understanding that risks of morbidity and mortality for OHS #3 and higher DOES increase by a not-insignificant amount in the adult population.
'AL Capshaw'
Before I start, of course everyone is different and not everyone will have the same results and any surgery DOES have risks but for the majority, especially IF they go to surgeons with experience in REDOS, this is pretty much what, I have learned or been told by several patients/parents who consults several centers, surgeons cardiologist
Also I am NOT saying REDOS are NOT risky..they ARE. Any surgery has risks, BUT my point is mechanical valves/coumadin also Have risks, so each person has to decide which risk they prefer, since both choices come with risks that are about the same..
From every surgeon I spoke to the past 20 years, The main risk with REDOS, especially multiple REDOs is scarring, both when they are cutting threw the sternum/getting to the heart and operating on the heart itself, especially if you are replacing a part that was operated on before. THAT risk is the same no matter what the age of the patient.
.Altho I personally would think it would be a little more difficult on the younger/ smaller children, where it is harder to see everything since their chest are just so small (When Justin had his 2nd surgery at 18 months his heart was a little bigger than a walnut, so you can imagine how small the arteries and veins were) Since Many complex CHDs require multiple REDOS before they are even adults, these are the surgeons for the most part that have the most experience with multiple REDOS and figure out the safest ways to operate and take care of the patients in ICU and everything they've learned in the past 20 years helps all patients who need REDOS. OF course like ALL surgeries IF you need a 3rd surgery, you should do your homework and go to the surgeons who do many multiple REDOS weekly, just like if you have an Aortic anneurysm you should go to the specialists to get the best results.
AS for Adults and what their results are right now, again I am sure alot has to do with where you go. but right now CCF does mainly Adults and about 1/3 of their surgeries are REDOs..they didn't break down what # REDO the surgeries were,
http://my.clevelandclinic.org/Documents/heart/OutcomePDFs/25_Valve_Disease.pdf
but their overall stats for all OHS are very good and many of their pateints are people who travel there because their surgery is risky or more complicated than most. Many of the other larger centers that mainly treat adults, also have very good over all stats, even tho many of their patients are having REDOS..
Most of the people I personally know of that have 3 or even 4 surgeries are children or adults with CHD and even for the adults..most surgeons tell them, the surgery is harder on the surgeons but as long as he goes slow and careful the chances of full recovery are the same no matter what number surgery it is.
Most of the studies done on REDOS are a majority of CHD patients since most of the people who need multiple surgeries ARE CHD patients, (since chances are IF you are 40 when you need your first valve replacement, even IF you choose a tissue valve you probably won't need MANY more OHS,(of course there will be some). For the MOST part, The people that need to have the most OHS are the ones born with complex CHDs, since many need 2 or 3 staged surgeries right from the beginning.
YES in this study "Repeat Sternotomy in Congenital Heart Surgery: No Longer a Risk Factor" the majority of patients were younger, the oldest was 45. BUT for the most part they also were having much more complex surgeries - (altho 72 were repeat AVRs) from the study- All RS (repeat sternotomy) between October 2002 and August 2006 were analyzed (602 RS in 558 patients). Median age was 3.6 years (range, 0.1 to 45.1); weight, 14.2 kg (2.0 to 112.2). Operations performed at RS were Glenn 22% (131), Fontan 21% (129), aortic valve repair/replacement 12% (72), right ventricle-pulmonary artery conduit 11% (67), Rastelli 7% (39), heart transplant 5% (31), and other 22% (133). Forty-seven percent of patients (280) had single-ventricle physiology. Incidence of second sternotomy was 67% (406), third 28% (166), fourth 4% (24), fifth 0.8% (5), and sixth 0.2% (1). A major injury upon RS was defined as one causing hemodynamic instability requiring vasopressor support or emergent transfusion; femoral cannulation or emergent cardiopulmonary bypass; and any morbidity. A minor injury is any other injury during RS.
(Me not part of study) 1/2 the patients were single ventricle patients, that for the most part makes them higher risk /harder to recover from than MOST, but of course not all, valve replacements.
" Results: The incidence of a major injury was not different between RS (0.3%; 2 of 602) and first-time sternotomy (0%; 0 of 1,274; p > 0.1). Incidence of a minor injury was 0.66% (4 of 602). No injury resulted in hemodynamic instability, neurologic injury, or death. Two patients (0.3%) required a nonemergent blood transfusion secondary to injury. (Nonemergent was defined as adminstration rate of less than 0.2 cc/kg/min and less than 10 cc/kg in total.) Femoral cannulation was performed in 4 of 602 RS cases (< 0.6%). Sternal wound infection was 0.5% (3 of 602); reoperation for postoperative bleeding was 1% (8 of 602). Median intensive care unit stay was 3 days (1 to 174); median hospital stay was 7 days (1 to 202). Hospital survival was 98%.
Conclusions: Repeat sternotomy can represent a negligible risk of injury and of subsequent morbidity or mortality. Therefore, the choice of management strategies for patients should not be affected by the need for RS."
http://ats.ctsnetjournals.org/cgi/content/full/86/3/897#FIG1
OF course people can still die or have life long problems from a first surgery. In MY opinion, just as the risks for REDOs have gotten so much better in the last 20 years as more and more of the babies with complex CHD were surving and surgeons learned the safest ways to perform REDOS to the point that they are as safe as they are right now with experienced surgeons, For someone having their first surgery NOW by the time they need their 3rd surgery (IF they ever do) The stats will be even better for everyone as more and more surgeons have experience with REDOS. Plus IF you are just getting your first valve now, like many/most people who join here and are asking questions, by the time THIS valve wears out especially IF for some reason they have other health problems happen that would make them higher risk, they would MOST LIKELY be able to avoid surgery and have their (2nd or 3rd) valve replaced in the cath lab.
I'm sorry to hear what you are going through, but happy you have someone by your side.
