title: Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database.
abstract: BACKGROUND
  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.
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: P
authors: P
authors: Kansara
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA. Electronic address: lawrence.czer@cshs.org.
authors: L
authors: L
authors: Czer
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: M
authors: M
authors: Awad
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: F
authors: F
authors: Arabia
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: J
authors: J
authors: Mirocha
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: M
authors: M
authors: De Robertis
authors: Section of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: J
authors: J
authors: Moriguchi
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: D
authors: D
authors: Ramzy
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: R M
authors: RM
authors: Kass
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: F
authors: F
authors: Esmailian
authors: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: A
authors: A
authors: Trento
authors: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
authors: J
authors: J
authors: Kobashigawa
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000151:congenital; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D056346:Sternotomy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States