title: Previous thoracic surgery does not increase peri-operative mortality in pediatric heart-lung transplant recipients.
abstract: BACKGROUND
  Heart-lung transplant (HLT) is indicated in select children with end-stage cardiopulmonary disease. We sought to determine whether previous thoracic surgery increases peri-operative morbidity and mortality.
  
  
  METHODS
  Retrospective data were analyzed using unpaired Student's t-test and Fisher's exact test. Results are reported as mean +/- SD. Peri-operative mortality was defined as death at </=30 days post-transplant.
  
  
  RESULTS
  From August 1993 through April 2001, 13 patients (mean age 7.9 +/- 5.3 years; 9 girls, 4 boys) underwent HLT at our center. Eight of 13 (62%) had previous thoracic surgery and 5 of 13 (38%) did not. Interval of last surgery to transplant date was 45.5 +/- 26.4 months (range 6 to 79 months). We compared HLT patients who had previous thoracic surgery to HLT recipients who did not. There was no significant difference in weight (18.6 +/- 14.3 vs 36.5 +/- 20.7 kg, p = 0.09), age (6.5 +/- 4.5 vs 10.2 +/- 6.1 years, p = 0.23) or duration of intubation (14.1 +/- 12.9 vs 17.0 +/- 30.3 days, p = 0.83). There were no caval or tracheal anastomotic stenoses in either group. There was no significant difference in blood products transfused </=48 hours after HLT: packed red blood cells (p = 0.16); fresh frozen plasma (p = 0.13); platelets (p = 0.59), and cryoprecipitate (p = 0.27). There was no difference in cardiopulmonary bypass time (129.3 +/- 48.2 vs 160.6 +/- 73.9 minutes, p 0.39); post-operative diaphragm dysfunction (4 of 8 vs 0 of 5, p = 0.1); re-exploration for bleeding (2 of 8 vs 1 of 5, p = 1.0); or peri-operative mortality (2 of 8 vs 0 of 5, p = 0.48).
  
  
  CONCLUSIONS
  We conclude that previous thoracic surgery in HLT recipients does not significantly increase blood product transfusion, cardiopulmonary bypass time or peri-operative mortality.
authors.affiliation: Division of Cardiology, Children's Hospital of Los Angeles, California 90027, USA.
authors.forename: Sofia
authors.initials: S
authors.lastname: Koulouri
authors.forename: Marlyn S
authors.initials: MS
authors.lastname: Woo
authors.forename: Monica V
authors.initials: MV
authors.lastname: Horn
authors.forename: Winfield J
authors.initials: WJ
authors.lastname: Wells
authors.forename: Vaughn A
authors.initials: VA
authors.lastname: Starnes
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Szmuszkovicz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016041:Heart-Lung Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects