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Updated: Oct 6, 2025
A Modified Murine Heterotopic Heart Transplant Protocol Matching Contemporary Standards of Aseptic Technique, Anesthesia, and Analgesia
Published on: September 28, 2022
Impact of prior sternotomy on survival and allograft function after heart transplantation: A single center matched
Carlo Mariani1, Antonio Loforte1, Gregorio Gliozzi1
1Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Insights
Prior sternotomy does not increase mortality or complications after orthotopic heart transplantation (OHT). This finding suggests that previous cardiac surgery is not a significant risk factor for OHT outcomes.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Research
Background:
- Orthotopic heart transplantation (OHT) is the gold standard for end-stage heart failure.
- A growing number of OHT candidates have undergone prior sternotomy, increasing surgical complexity.
- This study investigates the impact of prior sternotomy on OHT outcomes.
Purpose of the Study:
- To evaluate the association between prior sternotomy and outcomes after OHT.
- To determine if prior sternotomy is an independent risk factor for mortality and complications.
- To analyze the real burden of prior sternotomy in heart transplant recipients.
Main Methods:
- Retrospective analysis of 512 adult OHT patients (2000-2020).
- Patients divided into prior sternotomy (PS-group, n=131) and first sternotomy (FS-group, n=381) groups.
- Propensity score matching created 106 matched pairs for final analysis.
Main Results:
- No significant difference in 30-day mortality between PS-group and FS-group (7.5% vs. 5.7%).
- Prior sternotomy was not an independent risk factor for 90-day mortality (OR: 0.89, p=0.81).
- No significant difference in major postoperative complications (graft failure, AKI, bleeding, respiratory insufficiency, ECLS) or long-term survival between groups.
Conclusions:
- Prior sternotomy, despite increasing surgical complexity, does not independently predict adverse outcomes after OHT.
- Reoperation alone is not a significant risk factor impacting post-OHT results.
- These findings may help refine risk stratification for OHT candidates with prior sternotomy.
Background:
Orthotopic heart transplantation (OHT) remains the gold standard for the treatment of end-stage heart failure. The number of patients who have had at least one prior sternotomy while awaiting transplantation has increased over the years reaching 50% in the last ISHLT registry report. We analysed our institutional transplant activity focusing on prior-sternotomy setting to identify the real burden of this preoperative variable and its potential consequences.
Methods:
Between 2000 and 2020, a total of 512 consecutive adult patients underwent OHT. We divided them into two groups according to the previous sternotomy variable: a prior sternotomy group (PS-group, n = 131, 25.6%) and a heart transplant as first sternotomy group (FS-group, n = 381, 74.4%). After propensity score matching, a total of 106 matched-pairs were identified for the final analysis.
Results:
The overall 30-day mortality was similar in the two groups (7.5% vs. 5.7%, p = .58). The prior sternotomy was not an independent risk factor for 90-day mortality (odds ratio: 0.89, p = .81). In the matched sample, prior cardiac surgery was not predictive for any major postoperative complication: primary graft failure, AKI, bleeding, acute respiratory insufficiency, need for extra-corporeal life support (p > .05). The log-rank test revealed no significant difference between the two groups in the unmatched and matched pools (p = .93 and 0.69 respectively. At univariable analysis prior sternotomy was not associated with an increased risk of posttransplant mortality (hazard ratio: 0.87, p = .599).
Conclusions:
Despite it increases surgical complexity, the reoperation alone does not represent a proper risk factor and among different co-variates that may affect post-OHT outcomes.
