TY - JOUR
T1 - Reoperative sternotomy is associated with increased mortality after heart transplantation
AU - George, Timothy J.
AU - Beaty, Claude A.
AU - Ewald, Gregory A.
AU - Russell, Stuart D.
AU - Shah, Ashish S.
AU - Conte, John V.
AU - Whitman, Glenn J.
AU - Silvestry, Scott C.
N1 - Funding Information:
The authors would like to thank Ms Diane Alejo, Ms Tina Burmeister, Mr Joe Dinatale, Ms Barbara Fleischman, Mr Mike Sickinger, and Ms Jo Tyler for their support with data collection. This research was supported in part by grant T32 2T32DK007713-12 from the National Institutes of Health . Dr George is the Hugh R. Sharp Cardiac Surgery Research Fellow. Dr Beaty is the Irene Piccinini Investigator in Cardiac Surgery.
PY - 2012/12
Y1 - 2012/12
N2 - 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.
AB - 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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U2 - 10.1016/j.athoracsur.2012.07.039
DO - 10.1016/j.athoracsur.2012.07.039
M3 - Article
C2 - 22959569
AN - SCOPUS:84870043251
SN - 0003-4975
VL - 94
SP - 2025
EP - 2032
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -