Related Experiment Videos
Effect of prior sternotomy on mortality and morbidity after heart transplantation. Cardiac Transplant Team
R R Vijayanagar1, G L Chan, S S Weinstein
1Heart Transplant Service, Tampa General Hospital, Florida, USA.
Insights
Prior sternotomy impacts heart transplant outcomes. More than one prior sternotomy significantly increases 30-day mortality and lowers 1-year survival, posing risks for cardiac transplantation patients.
Area of Science:
- Cardiology
- Transplant Surgery
- Medical Outcomes Research
Background:
- Prior sternotomy is a common procedure in patients undergoing cardiac transplantation.
- The impact of previous sternotomy on cardiac transplant outcomes requires further investigation.
- Understanding these risks is crucial for patient selection and perioperative management.
Purpose of the Study:
- To evaluate the effect of prior sternotomy on the outcomes of primary heart transplantation.
- To identify specific risk factors associated with previous sternotomy in transplant recipients.
Main Methods:
- Retrospective analysis of 165 primary heart transplant recipients.
- Patients classified into three groups based on the number of prior sternotomies: none, one, or more than one.
- Comparison of demographic data, perioperative complications, and survival rates across groups.
Main Results:
- Mortality within 30 days post-transplant was significantly higher in patients with more than one prior sternotomy (31%) compared to those with none (7.8%) or one (8.5%).
- One-year actuarial survival was significantly lower in the 'more than one prior sternotomy' group (52%) versus the other groups (83% and 81%).
- More than one prior sternotomy and pulmonary hypertension were identified as independent risk factors for 30-day mortality. Increased coagulopathy and re-exploration for bleeding were also observed with prior sternotomies.
Conclusions:
- Multiple prior sternotomies are associated with significantly worse early and long-term outcomes following cardiac transplantation.
- Patients with a history of multiple sternotomies face increased risks of mortality, coagulopathy, and bleeding complications.
- Careful consideration of prior sternotomy history is essential for risk stratification and management in heart transplant candidates.
Abstract:
A retrospective analysis to evaluate the impact of prior sternotomy on the outcome of cardiac transplantation was undertaken. Some 165 patients who received primary heart transplantation were classified into three groups. There were 102 patients in group 1 (no prior sternotomy), 47 in group 2 (one prior sternotomy), and 16 in group 3 (more than one prior sternotomy). The three groups were demographically similar. Coronary artery bypass was the indication for prior sternotomy in 77% of patients in group 2 and in 94% in group 3. Mortality within 30 days post-transplant was significantly different among the three groups (group 1, 7.8%; group 2, 8.5%; group 3, 31%; P = 0.0148). The 1-year actuarial survival was also significantly lower in group 3 (52%) compared with groups 1 (83%) and 2 (81%) (P = 0.0311). Multivariate analysis identified more than one prior sternotomy and pulmonary hypertension as risk factors for death within 30 days post-transplant. Patients who had prior sternotomy also had a higher incidence of coagulopathy (group 1, 17%; group 2, 49%; group 3, 38%; P = 0.0002), and re-exploration due to excessive bleeding (group 1, 5%; group 2, 11%; group 3, 25%; P = 0.0225). Requirement for blood products for transfusion was also higher in groups 2 and 3. There was no significant difference among the three groups in the incidence of early infections (50% versus 53% versus 44%), renal failure (6% versus 11% versus 19%), or allograft rejection in patients who survived the first 30 days (95% versus 86% versus 82%).(ABSTRACT TRUNCATED AT 250 WORDS)