Early and long-term results of heart transplantation after previous cardiac surgery
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1Cardiac Transplant Unit, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
Insights
Redo heart transplantation in patients with prior cardiac surgery shows comparable long-term survival to first-time transplants. This justifies the procedure despite longer operation times and increased postoperative bleeding.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Cardiac Surgery Outcomes
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Previous cardiac surgery presents unique challenges for redo heart transplantation.
- Evaluating outcomes of redo heart transplantation is crucial for resource allocation.
Purpose of the Study:
- To compare long-term survival and outcomes of redo heart transplantation with primary heart transplantation.
- To assess preoperative management and postoperative variables in redo heart transplant recipients.
Main Methods:
- Retrospective analysis of 49 redo heart transplantations (Group A) versus 109 primary heart transplantations (Group B) between 1990-1997.
- Comparison of preoperative, intraoperative, and postoperative variables.
- Survival analysis including hospital mortality and 5-year survival rates.
Main Results:
- Redo heart transplantations had significantly longer operation times (311 min vs. 202 min) and increased postoperative bleeding requiring exploration (6/49 vs. 2/107).
- Greater postoperative blood loss and intensive care unit stay were observed in redo recipients.
- Hospital mortality (12.5% vs. 13%) and 5-year survival rates (68% vs. 71%) were similar between groups.
Conclusions:
- Redo heart transplantation is justified, demonstrating comparable long-term graft function and survival to primary procedures.
- Outcomes support performing redo heart transplantation even with organ scarcity.
- Long-term results for redo heart transplant recipients are similar to those undergoing transplantation as a first cardiac procedure.
Objectives:
The aim of this study was to evaluate the preoperative management and long-term survival of patients undergoing heart transplantation as a redo-operation and compare the results with those obtained in patients undergoing transplantation as their first cardiac surgical procedure.
Methods:
Between 1990 and 1997, 49 heart transplantation procedures were performed in patients who had undergone previous cardiac surgery (group A). This subgroup of patients was compared to 109 control patients who underwent cardiac transplantation as the primary cardiac procedure (group B). Patient groups were analysed regarding their preoperative, intra-operative, and postoperative variables in addition to survival.
Results:
Pre-operative events were comparable in both groups but the duration of the operation was longer for group A (311+/-68 min) compared to group B (202+/-34 min); P=0.02. Post-operative exploration for bleeding was 6/49 patients in group A compared to 2/107 patients in group B (P=0.02). Post-operative blood loss and intensive care stay were greater for group A (1302+/-360 ml and 6.1+/-3.1 days, respectively) compared to group B (763+/-126 ml and 4.1+/-1.9 days, respectively); P=0.02. There was no difference in hospital mortality (group A 12.5%, group B 13 % P=0.9) and the 5-year survival rates were 68 and 71% for group A and B, respectively (P=0.9).
Conclusions:
Heart transplantation after previous open cardiac surgery is entirely justified in terms of outcome and graft function even in time of profound organ scarcity. Long-term events in these recipients are similar to patients in whom transplantation is the primary procedure.
