Incidence of re-entry injury in repeat cardiac surgery and associated risk factor evaluated at a newly established cardiac center

Abstract

Background & Objective: Repeat cardiac surgery is often complicated by re-entry injuries and other risks, especially in patients with a history of prior cardiac procedures. The associated reason of repeat surgeries include complications such as graft failure, valve dysfunction, or disease recurrence. The procedure is categorized as higher risk profiles compared to primary surgical intervention. This study aimed to assess the frequency of re-entry injuries and other early complications in patients undergoing repeat cardiac surgery at a newly established cardiac center. Methodology: The study included patient’s data who visited cardiac surgery department of Peshawar Institute of Cardiology between January 2021 to February 2025. This retrospective study included 28 patients who underwent repeat cardiac surgery. Data on demographics, pre-operative status, comorbidities, and surgical procedures were collected from the hospital’s management information system (HMIS) and electronic medical records (EMR). The primary outcomes were re-entry injury frequency, postoperative complications, and 30-day mortality. Results: The study included 64.3% female patients, with a mean age of 38.89 years. Common pre-operative conditions included hypertension (32.1%) and advanced heart failure, with 71.4% of patients classified as NYHA class III and IV. The most frequent procedures were redo mitral valve replacement (MVR) and pseudoaneurysm repair. Central cannulation was used in 78.57% of cases, with a mean bypass time of 140.23 minutes. Conclusion: This study provides important insights into the characteristics, procedures, and outcomes of patients undergoing repeat cardiac surgery at a newly established cardiac centre with no re-entry injury. The findings indicate that the majority of patients were female, mostly presenting advanced heart failure and requiring complex, multivalve procedures. Central cannulation was the predominant method for cardiopulmonary bypass.