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Effect of prior cardiac surgery on survival after heart transplantation
D E Lammermeier1, T Nakatani, M S Sweeney
1Section of Transplantation, Texas Heart Institute, Houston 77225.
Insights
Prior cardiac operations do not impact long-term survival in heart transplant recipients. This retrospective analysis found similar survival rates for patients with and without previous cardiac surgery.
Area of Science:
- Cardiology
- Transplantation Surgery
- Immunology
Background:
- Prior cardiac operations are common in patients undergoing heart transplantation.
- The impact of previous cardiac surgery on heart transplant outcomes remains a concern.
Purpose of the Study:
- To determine if prior cardiac operations affect long-term survival after orthotopic heart transplantation.
- To compare outcomes between heart transplant recipients with and without a history of cardiac surgery.
Main Methods:
- Retrospective analysis of 182 adult orthotopic heart transplant recipients.
- Patients were divided into two groups: those with prior cardiac operations (Group I) and those without (Group II).
- Cyclosporine-based immunosuppression was administered to all patients.
Main Results:
- Group I patients were older and had a higher incidence of ischemic heart disease.
- Reoperation for bleeding was more frequent in Group I (25.0%) compared to Group II (8.2%).
- Actuarial 1-year and 3-year survival rates were comparable between Group I (77.6%, 66.5%) and Group II (77.1%, 66.3%).
Conclusions:
- Prior cardiac operation does not compromise long-term survival in heart transplant recipients.
- Careful patient selection and management can lead to successful outcomes despite previous cardiac surgery.
Abstract:
We conducted a retrospective analysis of 182 adult orthotopic heart transplant patients who underwent operations at our institution between July 1982 and October 1987 to determine whether prior cardiac operation affects survival. Group I included the 72 patients (39.6%) who had undergone a previous cardiac operation or operations and group II, the 110 (60.4%) who had not. The mean age of the patients in group I was 52.1 +/- 8.1 years and in group II, 46.1 +/- 10.2 years (p less than 0.01). The incidence of ischemic heart disease was 86.1% in group I and 29.1% in group II (p less than 0.01). All patients received cyclosporine-based immunosuppression. More patients in group I than in group II required reoperation for bleeding after transplantation: 18 (25.0%) versus 9 (8.2%) (p less than 0.01). The actuarial 1-year and 3-year survival rates were 77.6% and 66.5%, respectively, for group I and 77.1% and 66.3%, respectively, for group II. Because both groups had similar survival rates, we believe that prior cardiac operation in heart transplant recipients does not compromise long-term survival.