Perioperative Risk Assessment and Management of Redo Cardiac Surgery

Advances in percutaneous cardiac interventions for both coronary and valvular diseases have led to a decline in the number of redo cardiac surgical procedures. Patients who require redo cardiac surgery have typically exhausted percutaneous options, placing these patients in a high-risk category where surgical intervention remains the only viable option. Contemporary redo operations most often involve native or prosthetic valve endocarditis, aortic graft infections, or complex valvular reconstructions in patients with failing hearts. In addition, novel challenges have emerged following transcatheter valve replacement, leading to new forms of redo valve surgery. Redo coronary artery bypass grafting (CABG) has become uncommon due to the widespread use of durable arterial grafts at initial operation and the increasing expertise of interventional cardiologists in treating conduit or native vessel stenoses percutaneously. Patients who still require redo CABG often have multiple coronary stents, complicating surgical revascularization. Consequently, morbidity and mortality remain significantly higher for redo cardiac surgery compared with primary procedures. This review summarizes predictors of perioperative morbidity and mortality and outlines best practices in the risk assessment and management of patients undergoing redo cardiac surgery.