Repeat Sternotomy: No Longer a Risk Factor in Mitral Valve Surgical Procedures Mehrdad Ghoreishi, MD, Murtaza Dawood, MD, Gerald Hobbs, PhD, Chetan Pasrija,

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Repeat Sternotomy: No Longer a Risk Factor in Mitral Valve Surgical Procedures Mehrdad Ghoreishi, MD, Murtaza Dawood, MD, Gerald Hobbs, PhD, Chetan Pasrija, BS, Peter Riley, Lia Petrose, Bartley P. Griffith, MD, James S. Gammie, MD The Annals of Thoracic Surgery Volume 96, Issue 4, Pages 1358-1365 (October 2013) DOI: 10.1016/j.athoracsur.2013.05.064 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Patient population. (MV = mitral valve.) The Annals of Thoracic Surgery 2013 96, 1358-1365DOI: (10.1016/j.athoracsur.2013.05.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Protocol used for patients with a history of sternotomy undergoing mitral valve operation. (CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; MV = mitral valve.) The Annals of Thoracic Surgery 2013 96, 1358-1365DOI: (10.1016/j.athoracsur.2013.05.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Computed tomography scans of a patient at low risk and (B) a patient at high risk for intraoperative injury. The Annals of Thoracic Surgery 2013 96, 1358-1365DOI: (10.1016/j.athoracsur.2013.05.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Percentage of primary and repeat sternotomy mitral valve operations. The Annals of Thoracic Surgery 2013 96, 1358-1365DOI: (10.1016/j.athoracsur.2013.05.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier analysis of survival in for patients undergoing first-time sternotomy mitral valve operation (n = 926) (continuous line) compared with those who underwent repeat operation (n = 130). The Annals of Thoracic Surgery 2013 96, 1358-1365DOI: (10.1016/j.athoracsur.2013.05.064) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions