{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:12:34Z","timestamp":1785769954922,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Reoperative (redo) cardiac surgery carries elevated risk, yet determinants and mechanisms of early death in valve- and endocarditis-predominant cohorts are poorly described. We aimed to identify preoperative determinants of early mortality, derive a clinically usable risk model, examine the mechanisms of death, and evaluate EuroSCORE II. Methods: We analysed all redo cardiac operations through repeat sternotomy at a single tertiary centre (December 2010\u2013December 2025); the cohort comprised 821 patients with verified in-hospital mortality status. Independent preoperative predictors were identified by multivariable logistic regression. Discrimination and calibration of the model and of EuroSCORE II were compared, and procedural complexity, graded low-cardiac-output severity, postoperative morbidity, and failure-to-rescue were examined. Results: The early mortality rate was 22.8% (187\/821). The independent preoperative predictors were chronic kidney disease (adjusted odds ratio 2.25), age \u226570 years (2.32), active endocarditis (1.89), advanced functional class (1.78), non-elective status (1.69), and systolic pulmonary artery pressure (1.15 per 10 mmHg); the model discriminated and calibrated well (concordance statistic 0.755). EuroSCORE II discriminated similarly but systematically under-predicted mortality (observed-to-expected ratio 1.46; worst 2.06 at intermediate risk). Mortality rose with procedural complexity (17.3% to 37.3%) and graded haemodynamic support (3.4% to 79.1%). Failure-to-rescue was 38.5%, compared with 5.8% mortality in patients without a major complication. A standard-risk subgroup (n = 209) had 12.4% mortality. Conclusions: Early mortality after redo cardiac surgery is driven by identifiable preoperative comorbidity, procedural complexity, and low-cardiac-output physiology, and is concentrated in failure-to-rescue. A parsimonious preoperative model predicted mortality well; EuroSCORE II, although discriminating, systematically under-predicted risk, supporting redo-specific assessment and recalibration.<\/jats:p>","DOI":"10.3390\/diagnostics16152451","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:16:27Z","timestamp":1785766587000},"page":"2451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Mortality in Reoperative Cardiac Surgery: Determinants, Prediction, and Calibration"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9575-0100","authenticated-orcid":false,"given":"Abdul Kerim","family":"Bu\u011fra","sequence":"first","affiliation":[{"name":"Cardiovascular Surgery Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, 34303 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuba","family":"Mutu","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, 34303 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-9730","authenticated-orcid":false,"given":"Burak","family":"Ersoy","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, 34303 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3628-8080","authenticated-orcid":false,"given":"Zihni Mert","family":"Duman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Pamukkale University, 20070 Denizli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5640-8329","authenticated-orcid":false,"given":"Ayt\u00fcl","family":"Bu\u011fra","sequence":"additional","affiliation":[{"name":"Morgue Department, Council of Forensic Medicine, Ministry of Justice, 34196 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1056\/NEJMoa1613792","article-title":"Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement","volume":"377","author":"Goldstone","year":"2017","journal-title":"N. 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