Prior Sternotomy Increases the Mortality and Morbidity of Adult Heart Transplantation

Abstract Background This study investigated the effect of prior sternotomy (PS) on the postoperative mortality and morbidity after orthotopic heart transplantation (HTx). Methods Of 704 adults who underwent HTx from December 1988 to June 2012 at a single institution, 345 had no PS (NPS group) and 35...

Full description

Saved in:
Bibliographic Details
Published in:Transplantation proceedings 2015-03, Vol.47 (2), p.485-497
Main Authors: Awad, M, Czer, L.S.C, Mirocha, J, Ruzza, A, Rafiei, M, Reich, H, De Robertis, M, Rihbany, K, Pinzas, J, Ramzy, D, Arabia, F, Trento, A, Kobashigawa, J, Esmailian, F
Format: Article
Language:English
Subjects:
Adult
Aged
Critical Care
Female
Heart Failure - mortality
Heart Failure - surgery
Heart Transplantation - adverse effects
Heart Transplantation - mortality
Heart-Assist Devices
Humans
Length of Stay
Male
Middle Aged
Reoperation - adverse effects
Reoperation - mortality
Retrospective Studies
Sternotomy - adverse effects
Surgery
Survival Rate
Time Factors
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background This study investigated the effect of prior sternotomy (PS) on the postoperative mortality and morbidity after orthotopic heart transplantation (HTx). Methods Of 704 adults who underwent HTx from December 1988 to June 2012 at a single institution, 345 had no PS (NPS group) and 359 had ≥1 PS (PS group). Survival, intraoperative use of blood products, intensive care unit (ICU) and hospital stays, frequency of reoperation for bleeding, dialysis, and >48-hour ventilation were examined. Results The NPS and PS groups had similar 60-day survival rates (97.1 ± 0.9% vs 95.3 ± 1.1%; P  = .20). However, the 1-year survival was higher in the NPS group (94.7 ± 1.2% vs 89.7 ± 1.6%; hazard ratio [HR], 1.98; 95% CI, 1.12–3.49; P  = .016). The PS group had longer pump time and more intraoperative blood use ( P  < .0001 for both). Postoperatively, the PS group had longer ICU and hospital stays, and higher frequencies of reoperation for bleeding and >48-hour ventilation ( P  < .05 for all comparisons). Patients with 1 PS (1PS group) had a higher 60-day survival rate than those with ≥2 PS (2+PS group; 96.7 ± 1.1% vs 91.1 ± 3.0%; HR, 2.70; 95% CI, 1.04–7.01; P  = .033). The 2+PS group had longer pump time and higher frequency of postoperative dialysis ( P  < .05 for both). Patients with prior VAD had lower 60-day (91.1 ± 3.0% vs 97.1 ± 0.9%; P  = .010) and 1-year (87.4 ± 3.6% vs 94.7 ± 1.2%; P  = .012) survival rates than NPS group patients. Patients with prior CABG had a lower 1-year survival than NPS group patients (89.0 ± 2.3% vs 94.7 ± 1.2%; P  = .018). Conclusion The PS group had lower 1-year survival and higher intraoperative blood use, postoperative length of ICU and hospital stays, and frequency of reoperation for bleeding than the NPS group. Prior sternotomy increases morbidity and mortality after HTx.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2014.10.009