Objectives
Congenital cardiac surgery in adults with congenital heart disease (ACHD) presents major difficulties in management and technique. Although, reoperations are more frequent than primary surgery in these patients, limited knowledge exists on perioperative risk factors associated with reoperations.

Methods
From January 2002 to December 2007, 164 ACHD (mean age±SD: 31±12.4 years) underwent reoperation in our institute. All the pre, intra, and postoperative data were retrospectively analysed in order to identify perioperative risks factors for mortality and morbidity. The most frequent reoperations performed were: pulmonary valve implantation n=43, conduit replacement n=17, residual ASD closure n=16, various aortic valve procedures n=15, conversion to modified Fontan circuit n=13 and Bentall operation n=12.

Results
Early mortality was 3.6% (n=5). Mean mechanical ventilation time was 26 hours; mean intensive care stay was 3.1 days; mean postoperative hospital stay was 8.2 days. Serious postoperative complications occurred in 24 patients (15.1%). Cardiopulmonary by-pass time (p=0.001), correction after palliation (p=0.004), preoperative hematocrit (p=0.004), previous number of operations (p=0.01) and the presence of preoperative congestive heart failure (p=0.02) were significant perioperative risk factors for severe morbidity. No significant perioperative risk factors associated with mortality were found.

Conclusions
Reoperations in ACHD are mostly for right ventricular outflow tract lesions and can be associated with low risk if performed meticulously and in larger centres with high volume of reoperations. Important perioperative risk factors for morbidity remain high hematocrit (cyanosis), congestive cardiac failure, number of previous operations, long standing palliated heart and long cardiopulmonary by-pass time.