Reoperative heart surgery, sometimes called “redo heart surgery,” is when an individual who has previously had heart surgery needs to undergo another heart operation to treat complications or problems that have arisen since the previous surgery.

Over recent decades, heart surgery techniques and procedures have improved enormously. As a result, people who underwent heart surgery, whether for a heart valve replacement, coronary artery bypass, or another procedure, are living longer than ever before. It sometimes happens that problems get worse, even after a previous heart surgery, or it could be that tissues used to replace diseased or damaged heart structures develop complications. In these cases, an additional heart surgery—or surgeries—is needed to ensure continuing heart health.

Reoperative heart surgery is essentially a “redo” of a previous heart surgery. It’s done to treat and correct heart problems that have developed since the surgery.

Reoperative heart surgery is primarily done to replace heart valves that have deteriorated over time or to redo a coronary bypass that has become narrowed or blocked over several years. It’s also done to treat problems that affect the aorta after a previous surgery and/or to take care of other issues that arise after heart surgery.

Yes, for several reasons:

• Age. Patients may be significantly older and less healthy than they were for the initial surgery.
• Adhesions. Adhesions are scar-like bands of tissue that can develop after surgery. These can cause organs and tissues in the chest cavity to stick together abnormally, making the surgery more difficult.

It’s important to note that, while reoperative heart surgery is more complex than an initial heart surgery, it can relieve symptoms caused by heart problems and help people live longer, healthier lives.

Reoperative heart surgeries include, but are not limited to, the following:

• Reoperative heart valve replacement or repair. Redo surgery may be necessary for people who have had a diseased or defective heart valve replaced or repaired. There are two main types of replacement heart valves: Tissue (made of animal or human tissue) or mechanical (made of plastic or metal). Over time, tissue valves deteriorate and typically must be replaced after about 10 to 20 years. Mechanical valves last longer but may need to be replaced if they fail or if blood clots form within them. Tissue and mechanical valves may also need to be replaced if, in rare instances, they become infected.
• Reoperative coronary artery bypass grafting (CABG). If coronary arteries become narrowed or obstructed—usually due to plaque buildup—blood flow to the heart can be restricted or even blocked. CABG is a surgical procedure in which healthy blood vessels from elsewhere in the body are grafted onto a coronary artery above and below the site of the narrowing or obstruction, thereby restoring blood flow through the artery. While the initial CABG procedure may have been successful, over time, the blood vessels used as grafts may also become narrowed or blocked by plaque buildup. When this happens, the initial strategy is usually percutaneous coronary intervention (PCI), but in some instances, that is not possible and a second CABG surgery may be necessary.
• Reoperative surgeries for people with congenital heart disease. Congenital heart diseases are defects in the heart’s structure that are present at birth. Children born with a heart defect may need heart surgery to correct the problem. Sometimes, an additional heart surgery, or in some cases, multiple additional heart surgeries, may be necessary later in childhood, adolescence, and/or adulthood.
• Reoperative aortic aneurysm or aortic dissection repair. An aortic aneurysm occurs when the walls of the aorta bulge abnormally. Over time, aneurysms grow, and their risk of rupturing—a life-threatening emergency—increases. Aneurysms also increase the risk of aortic dissection, a condition in which a tear forms in the inner layer of the aorta’s wall. Aortic aneurysms are typically treated with surgery. In some cases, after the initial surgery, problems with the aorta may arise, including complications with the aortic valve, aneurysm, and/or dissection. Reoperative surgery may be necessary to treat these conditions.

Before undergoing reoperative heart surgery, your doctor will closely review your medical history, including details from your previous heart surgery, such as the type of surgery, types of incisions used, and whether you experienced any postoperative complications. You will also undergo a physical exam that assesses your heart function and your overall health to determine whether you are healthy enough for the procedure.

Additional tests are usually necessary prior to the reoperation. These typically include imaging studies, such as a computed tomography angiogram (CTA) of the chest. Often, the CT scan will extend to the abdomen and pelvis. An echocardiogram—an ultrasound of the heart—is another commonly used preoperative imaging test.

Before the procedure, you may need to adjust or stop taking certain medications, such as blood thinners.

Reoperative heart surgery may be done using one of the following techniques:

• Open heart surgery. In an open-heart procedure, the surgeon makes a long incision down the center of the chest, then cuts through the breastbone (the sternum) to access the heart and blood vessels. This procedure is known as a sternotomy. In addition, a heart-lung bypass machine, which takes over the functions of the heart and lungs during the procedure, may be required.
• Thoracotomy. In this procedure, the surgeon makes an incision and accesses the heart and blood vessels through the ribs. The heart may also be connected to a heart-lung bypass machine during the procedure.
• Minimally invasive surgery. Some heart procedures can be performed via one or more small incisions in the chest. For instance, surgeons may gain access to the heart using a mini-sternotomy or a mini-thoracotomy. The patient’s heart may need to be connected to a heart-lung bypass machine during these procedures, which are similar to the techniques described above, but involve smaller incisions and usually offer a faster recovery.
• Percutaneous interventions. Some heart procedures, such as aortic valve replacements and some aortic aneurysm repairs, may be performed percutaneously. In this technique, the surgeon makes a small incision, usually in the groin, to access an artery. Then, a catheter—a thin tube—is inserted into the artery and guided to the blood vessel where the problem occurs. The surgeon performs the procedure using tiny surgical tools that can be inserted through the catheter.

The time it takes to recover depends on the type of surgery. For heart surgeries in general, recovery typically involves spending time in the hospital and a day or more in the intensive care unit (ICU). After getting discharged from the hospital, patients should continue to see their doctor regularly for follow-up appointments and monitoring.

Like all surgical procedures, reoperative heart surgery carries certain risks. While complications are rare, they may include:

• Bleeding
• Infection
• Heart arrhythmias
• Blood clots
• Damage to other tissues (heart, kidneys, liver, and/or lungs)

While complications can occur after reoperative heart surgery, they are uncommon. In most cases, the surgery successfully reduces symptoms and improves heart function. However, people who undergo redo heart surgery may need to take medications and see their doctor for regular check-ups and monitoring.

“Being a quaternary referral center for heart surgery, we frequently see patients that have prior cardiac surgery and need a reoperation on the heart,” says Arnar Geirsson, MD, chief of the Division of Cardiac Surgery at Yale Medicine. “These are most often complex cases that are associated with a higher risk than the first operation. We strive to have the best outcomes for our patients, and the cardiac surgeons at Yale use cutting-edge techniques and tools that provide for the highest level of care in these complex cases.”