title: Prior sternotomy increases the mortality and morbidity of adult heart transplantation.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Awad
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California. Electronic address: lawrence.czer@cshs.org.
authors.forename: L S C
authors.initials: LS
authors.lastname: Czer
authors.affiliation: Section of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Mirocha
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: A
authors.initials: A
authors.lastname: Ruzza
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: Rafiei
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: H
authors.initials: H
authors.lastname: Reich
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: M
authors.initials: M
authors.lastname: De Robertis
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: K
authors.initials: K
authors.lastname: Rihbany
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Pinzas
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: D
authors.initials: D
authors.lastname: Ramzy
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Arabia
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.affiliation: Division of Cardiology, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: J
authors.initials: J
authors.lastname: Kobashigawa
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: F
authors.initials: F
authors.lastname: Esmailian
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome