Predictors of Survival in Resternotomy Following Primary Cardiac Surgery: A Retrospective Cohort Study

Background: Cardiac surgery significantly improves survival and quality of life for patients with cardiovascular diseases. However, some patients require chest re-exploration to manage complications such as bleeding, hemodynamic instability, or cardiac tamponade. Despite advancements in cardiac surgery, chest re-opening surgeries present high-risk challenges associated with increased mortality rates and prolonged recovery.
Objectives: This study aimed to identify the demographic, clinical, and perioperative factors influencing outcomes in patients undergoing chest re-exploration.
Patients and Methods: This retrospective cohort study analyzed 497 patients who underwent primary cardiac surgery between March 2021 and March 2025 at multicenters of the authors. Of these, 25 required chest re-exploration within 30 days. Demographic, clinical, and surgical variables were extracted from medical records, and factors such as re-exploration timing, blood loss, hematocrit, lactate levels, and extracorporeal circulation (ECC) time were analyzed.
Results: Among the 25 patients who underwent chest re-exploration, 23 (92%) survived, while 2 (8%) died. Moreover, non-survivors had significantly higher pre-re-exploration blood loss, lower hematocrit levels, elevated lactate concentrations, prolonged ECC times, and longer time to re-exploration. In addition, no significant demographic differences were observed between survivors and non-survivors. The study revealed that key factors such as timely re-exploration, blood loss, and biochemical markers (hematocrit and lactate levels) significantly influenced outcomes following chest re-exploration.
Conclusions: Understanding the predictors of survival in patients undergoing chest re-exploration is crucial for improving clinical outcomes. Early identification of high-risk patients improves survival rates, suggesting the need for enhanced perioperative monitoring. Further prospective studies are needed to validate these findings and develop strategies that enhance patient safety during chest re-exploration in cardiac surgery.