Related Experiment Videos
Perioperative risk and long-term results of heart transplantation after previous cardiac operations
1Clinic for Cardiovascular Surgery, University Hospital Zürich, Switzerland.
Insights
Redo heart transplantation in patients with prior cardiac operations shows acceptable perioperative risk and long-term survival comparable to primary heart transplantation. Careful patient selection is key for successful outcomes in these complex cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Increasing number of heart transplant candidates have undergone previous cardiac surgeries.
- Prior cardiac operations may pose challenges for heart transplantation.
Purpose of the Study:
- To analyze perioperative management and long-term survival of redo heart transplantation.
- Compare outcomes of redo vs. primary heart transplantation.
Main Methods:
- Retrospective case-control study of 204 heart transplantations (1985-1994).
- 38 patients with prior cardiac operations compared to 76 primary transplant patients.
- Analysis of perioperative variables, mortality, and survival rates.
Main Results:
- No significant difference in perioperative risk or long-term survival between redo and primary heart transplant groups.
- Hospital mortality: 5.2% (redo) vs. 7.8% (primary).
- 1-year survival: 92.7% (redo) vs. 90.8% (primary); 5-year survival: 79.4% (redo) vs. 74.8% (primary).
Conclusions:
- Carefully selected redo heart transplant candidates do not face significantly higher perioperative risk.
- Early and late rejection episodes and postoperative infections are similar between groups.
- Prior operations are not a significant risk factor for heart transplantation, unlike lung or heart-lung transplantation.
Background:
In recent years, there has been an increasing proportion of candidates for heart transplantation who have sustained one or several previous cardiac operations. This study analyzes the perioperative management and the long-term survival of patients undergoing orthotopic heart transplantation as a redo operation and compares the results with those obtained in patients undergoing transplantation as the first cardiac operation.
Methods:
From October 1985 to October 1994, 204 heart transplantations were performed in 202 patients. Thirty-eight transplantations were performed in patients who had undergone prior cardiac operations because of coronary artery disease (n = 21) and valvular disease (n = 8) as well as one or several palliative or corrective procedures because of complex congenital heart disease (n = 9). These 38 patients were compared in a case-control fashion with 76 patients who underwent orthotopic cardiac transplantation as a primary cardiac procedure during the same period and using similar techniques. The majority of preoperative variables (hemodynamics, inotropic support, liver and renal function, coagulation, and priority to transplantation) were comparable in the two groups of patients. Mean age was significantly younger in the group of patients with a previous operation (42.2 +/- 9.5 versus 50.1 +/- 7.3 years; p < 0.001).
Results:
Except the problem of more fastidious hemostasis, which is nowadays under better control since aprotinin has been routinely administered, the results show no significant difference in term of perioperative risk (hospital mortality: 5.2% in study group versus 7.8% in the control group) and long-term outcome. The 1-year survival rate was 92.7% +/- 3.6% in the study group versus 90.8% +/- 3.6% in the control group, and the 5-year survival rate was 79.4% +/- 4.5% versus 74.8% +/- 7.5%, respectively.
Conclusions:
These results are very acceptable and confirm the fact that carefully selected candidates for transplantation are not exposed to a particularly high perioperative risk when a prior cardiac operation has been performed. The incidences of early and late rejection episodes as well as the numbers of postoperative infections are similar in the two groups. Although multiple prior procedures do constitute significant risk factors for perioperative morbidity and mortality in isolated lung and heart-lung transplantation, this is not the case in heart transplantation.