Details

Autor(en) / Beteiligte

• Ott, Gary Y.
• Norman, Douglas J.
• Hosenpud, Jeffrey D.
• Hershberger, Ray E.
• Ratkovec, Ranae M.
• Cobanoglu, Adnan

Titel

Heart transplantation in patients with previous cardiac operations

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 1994-01, Vol.107 (1), p.203-209

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

1994

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• A significant proportion of potential transplant recipients have undergone previous cardiac procedures and may be subject to an increased risk because of technical and other factors inherent in a reoperation. Between December 1985 and June 1991, 155 orthotopic heart transplantations were carried out in 146 patients. Eighty-five transplantations (54.8%) were carried out as the initial cardiac operation (group I); 61 operations (45.2%) were performed in patients who had previous nontransplant cardiac operations (group II). Preoperative variables including hemodynamic indexes, renal function, and status on the waiting list were similar between these groups; however, group II patients tended to be older than group I patients (51.9 ± 10.7 versus 47.7 ± 11.6 years, respectively; p < 0.05) and were more likely to have ischemic heart disease (80.3% versus 34.1%) than were those in group I. Significantly longer cardiopulmonary bypass time (127.6 ± 44.7 minutes versus 108.2 ± 18.8 minutes, p < 0.01) and duration of operation (448.1 ± 120.9 minutes versus 353.2 ± 85.1 minutes, p < 0.01) was found in group II. Operative mortality in group I was 4.7% and in group II was 6.6% ( p > 0.9). Group I actuarial survival at 1 year and 5 years was 87.1% ± 3.6% and 72.9% ± 6.2%, respectively. Group II actuarial survival was 85.3% ± 4.5% and 76.0% ± 6.6%, respectively, for the same time periods. In spite of the greater technical challenge implied by previous cardiac operations, no significant survival differences occurred between these groups ( p > 0.9). However, patients undergoing a second cardiac transplantation ( n = 9) were identified as a high-risk subset with operative mortality of 22.8% and 1-year survival of only 33.3% ± 15.7% ( p < 0.0003). Cardiac transplantation in patients who have undergone previous nontransplant cardiac operations can be carried out without compromising immediate or long-term outcome. (J THORACCARDIOVASCSURG1994;107:203-9)