Prior Sternotomy Increases the Mortality and Morbidity of Adult Heart Transplantation

• This retrospective analysis represents the largest single-center report analyzing the effect of prior sternotomy on the morbidity and mortality after cardiac transplantation.
• Compared with transplant patients having no prior sternotomy, patients with prior sternotomy required more perioperative blood transfusion and had longer intraoperative pump time, higher postoperative creatinine levels, longer intensive care and hospital stays, greater frequencies of postoperative reoperation for chest bleeding, elongated ventilation, and sepsis, as well as a lesser 1-year survival.
• Compared with transplant patients having 1 prior sternotomy, patients with ≥2 prior sternotomies had a longer intraoperative pump time, higher postoperative peak creatinine levels, and greater frequencies of postoperative dialysis and pneumonia, as well as a lesser 60-day survival.

BackgroundThis study investigated the effect of prior sternotomy (PS) on the postoperative mortality and morbidity after orthotopic heart transplantation (HTx).MethodsOf 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.ResultsThe 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).ConclusionThe 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.