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Axtell AL, Fiedler AG, Lewis G, Melnitchouk S, Tolis G, D’Alessandro DA, Villavicencio MA. Reoperative sternotomy is associated with increased early mortality after cardiac transplantation. Eur J Cardiothorac Surg 2019; 55:1136-1143. [DOI: 10.1093/ejcts/ezy443] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea L Axtell
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Amy G Fiedler
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - George Tolis
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - David A D’Alessandro
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mauricio A Villavicencio
- Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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Still S, Shaikh AF, Qin H, Felius J, Jamil AK, Saracino G, Chamogeorgakis T, Rafael AE, MacHannaford JC, Joseph SM, Hall SA, Gonzalez-Stawinski GV, Lima B. Reoperative sternotomy is associated with primary graft dysfunction following heart transplantation†. Interact Cardiovasc Thorac Surg 2018; 27:343-349. [DOI: 10.1093/icvts/ivy084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/22/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sasha Still
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Asad F Shaikh
- College of Medicine, Texas A&M Health Science Center, Dallas, TX, USA
| | - Huanying Qin
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Aayla K Jamil
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Giovanna Saracino
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Themistokles Chamogeorgakis
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Aldo E Rafael
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Juan C MacHannaford
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Susan M Joseph
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Gonzalo V Gonzalez-Stawinski
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Brian Lima
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
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Prior sternotomy increases the mortality and morbidity of adult heart transplantation. Transplant Proc 2015; 47:485-97. [PMID: 25769596 DOI: 10.1016/j.transproceed.2014.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/05/2014] [Indexed: 11/24/2022]
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.
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Kansara P, Czer L, Awad M, Arabia F, Mirocha J, De Robertis M, Moriguchi J, Ramzy D, Kass RM, Esmailian F, Trento A, Kobashigawa J. Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database. Transplant Proc 2015; 46:249-55. [PMID: 24507061 DOI: 10.1016/j.transproceed.2013.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/26/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with history of prior sternotomy may have poorer outcomes after heart transplantation. Quantitation of risk from prior sternotomy has not been well established. The United Network for Organ Sharing (UNOS) database was analyzed to assess early and late survival and predictors of outcome in adult heart transplant recipients with and without prior sternotomy. METHODS Of 11,266 adults with first heart-only transplantation from 1997 to 2011, recipients were divided into 2 groups: those without prior sternotomy (first sternotomy group; n = 6006 or 53.3%) and those with at least 1 prior sternotomy (redo sternotomy group; n = 5260 or 46.7%). A multivariable Cox model was used to identify predictors of mortality. RESULTS Survival was lower in the redo group at 60 days (92.6% vs 95.9%; hazard ratio [HR] 1.83, 95% confidence interval [CI]: 1.56-2.15; P < .001). Conditional 5-year survival in 60-day survivors was similar in the 2 groups (HR = 1.01, 95% CI 0.90-1.12, P = .90). During the first 60 days post-transplant, the redo group had more cardiac reoperations (12.3% vs 8.8%, P = .0008), a higher frequency of dialysis (8.9% vs 5.2%, P < .0001), a greater percentage of drug-treated infections (23.2% vs 19%, P = .003), and a higher percentage of strokes (2.5% vs 1.4%, P = .0001). A multivariable Cox proportional hazards model identified prior sternotomy as a significant independent predictor of mortality, in addition to age, female gender, congenital cardiomyopathy, need for ventilation, mechanical circulatory support, dialysis prior to transplant, pretransplant serum bilirubin (≥ 3 mg/dL), and preoperative serum creatinine (≥ 2 mg/dL). CONCLUSIONS Prior sternotomy is associated with an excess 3.3% mortality and higher morbidity within the first 60 days after heart transplantation, as measured by frequency of dialysis, drug-treated infections, and strokes. Conditional 5-year survival after 60 days is unaffected by prior sternotomy. These findings should be taken into account for risk assessment of patients undergoing heart transplantation.
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Affiliation(s)
- P Kansara
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - L Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
| | - M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Mirocha
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - M De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Moriguchi
- Section of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - R M Kass
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
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George TJ, Beaty CA, Ewald GA, Russell SD, Shah AS, Conte JV, Whitman GJ, Silvestry SC. Reoperative sternotomy is associated with increased mortality after heart transplantation. Ann Thorac Surg 2012; 94:2025-32. [PMID: 22959569 DOI: 10.1016/j.athoracsur.2012.07.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 05/26/2012] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although several studies have examined factors affecting survival after orthotopic heart transplantation (OHT), few have evaluated the impact of reoperative sternotomy. We undertook this study to examine the incidence and impact of repeat sternotomies on OHT outcomes. METHODS We conducted a retrospective review of all adult OHT from 2 institutions. Primary stratification was by the number of prior sternotomies. The primary outcome was survival. Secondary outcomes included blood product utilization and commonly encountered postoperative complications. Multivariable Cox proportional hazards regression models examined mortality while linear regression models examined blood utilization. RESULTS From January 1995 to October 2011, 631 OHT were performed. Of these, 25 (4.0%) were redo OHT and 182 (28.8%) were bridged to transplant with a ventricular assist device; 356 (56.4%) had undergone at least 1 prior sternotomy. On unadjusted analysis, reoperative sternotomy was associated with decreased 90-day (98.5% vs 90.2%, p<0.001), 1-year (93.1% vs 79.6%, p<0.001), and 5-year (80.4% vs 70.1%, p=0.002) survival. This difference persisted on multivariable analysis at 90 days (hazard ratio [HR] 2.99, p=0.01), 1 year (HR 2.98, p=0.002), and 5 years (HR 1.62, p=0.049). The impact of an increasing number of prior sternotomies was negligible. On multivariable analysis, an increasing number of prior sternotomies was associated with increased intraoperative blood product utilization. Increasing blood utilization was associated with decreased 90-day, 1-year, and 5-year survival. CONCLUSIONS Reoperative sternotomy is associated with increased mortality and blood utilization after OHT. Patients with more than 1 prior sternotomy do not experience additional increased mortality. Carefully selected patients with multiple prior sternotomies have decreased but acceptable outcomes.
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Affiliation(s)
- Timothy J George
- Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Handa N, McGregor CGA, Daly RC, Dearani JA, Edwards BS, Frantz RP, Olson LJ, Rodeheffer RJ. Heart transplantation for radiation-associated end-stage heart failure. Transpl Int 2000. [DOI: 10.1111/j.1432-2277.2000.tb01058.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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