Previous open heart operation: a contribution to impaired outcome after cardiac transplantation?
BACKGROUND
There is still debate about whether previous cardiac operations are a risk factor for patient outcome after cardiac transplantation. As waiting lists for cardiac transplantation increase, adverse outcome criteria should be identified.


METHODS
To assess this problem, we retrospectively analyzed 53 patients with previous cardiac operations before heart transplantation and compared them with 53 control patients matched for sex and age. Patient groups were analyzed regarding their preoperative, intraoperative, and postoperative variables and survival.


RESULTS
Ischemic times were comparable in both groups, but the duration of the operation was significantly longer in the study group (206.5 +/- 62.5 minutes, versus 156.0 +/- 36.7 minutes in controls; p < 0.05). In addition, postoperative blood loss was greater for the patients with previous cardiac operations (1,360 +/- 260 mL, versus 730 +/- 310 mL for controls; p < 0.01). Postoperatively, the rate of rejection episodes and the incidence of graft atherosclerosis were comparable within the first 2 years. However, survival was significantly reduced in the study group (60.1%) after 4 years (versus 83.1% for controls; p < 0.05).


CONCLUSIONS
Heart transplantation in patients with previous cardiac operations will lead to an impaired overall outcome. In addition, these patients have more postoperative complications.
Uthoff
K
K
Surgical Department, Hannover Medical School, Germany.
Wahlers
T
T
Cremer
J
J
Borst
H G
HG
D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
D007166:Immunosuppressive Agents