Stacking sternotomies: Does surgical history predict post-transplant risk?

Area of Science:

• Cardiology
• Thoracic Surgery
• Transplantation Medicine

Background:

• Prior sternotomy is a known risk factor for heart transplantation (HT) outcomes.
• The incremental risk of multiple prior sternotomies on post-transplant survival is not well-established.

Purpose of the Study:

• To compare post-transplant outcomes among heart transplant recipients with zero, one, or two or more prior sternotomies.
• To determine if additional sternotomies beyond the first confer incremental mortality risk.

Main Methods:

• Retrospective review of heart transplant recipients from January 2020 to December 2024 at a single center.
• Patients stratified into groups based on the number of prior sternotomies: 0, 1, and ≥2.
• Multivariable Cox and logistic regression models used to compare mortality, blood product transfusions, and vasoplegia.

Main Results:

• Compared to primary sternotomy, one prior sternotomy was associated with significantly lower 30-day, 1-year, and 2-year survival.
• Two or more prior sternotomies also showed significantly reduced survival at all time points compared to primary sternotomy.
• No statistically significant difference in mortality hazards was observed between the one and ≥2 prior sternotomy groups.
• Reoperative sternotomy patients required more blood products and experienced more vasoplegia.

Conclusions:

• Reoperative sternotomy increases the risk of blood product use, vasoplegia, and mortality after heart transplantation.
• While prior sternotomy is detrimental, undergoing more than one prior sternotomy does not appear to confer a statistically significant additional mortality risk compared to a single prior sternotomy.