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The Influence of Prior Median Sternotomy on Outcome of Heart Transplantation

Division of Thoracic and Cardiovascular Surgery 1 Section of Biostatistics Mayo Clinic and Foundation Rochester, Minnesota, USA

Christopher GA McGregor, MB, FRCS Cardiothoracic Transplantation Mayo Clinic and Mayo Foundation 200 First Street SW Rochester, MN 55905, USA Tel:1 507 255 6038 Fax:1 507 255 4500 Email:mcgregor.christopher{at}mayo.edu

This study is a retrospective analysis of the influence of previous cardiac surgery on the outcome of heart transplantation in 118 consecutive recipients from January 1988 to December 1996. Group 1 consisted of 67 patients who had no previous sternotomy, group 2 was 33 patients who had one previous sternotomy, and group 3 was 18 patients who had two or more previous sternotomies. The three groups were demographically similar apart from the indication for transplantation and the sex distribution. Preoperative hemodynamic data, except systolic pulmonary artery pressure, were similar among the three groups. There was no significant difference in hospital mortality, 1-year and 5-year actuarial survival rates, incidence of renal dysfunction requiring dialysis, prolonged respiratory support, elevated total bilirubin, re-exploration for bleeding, incidence of mediastinitis, or postoperative hospital stay between the groups. The rejection-free and infection-free survival rates were similar in the three groups. However, previous sternotomy resulted in significantly longer cardiopulmonary bypass times and increased requirement for blood and blood products. The use of a cell saver limited the need for stored red blood cells. This study demonstrated no survival disadvantage of previous sternotomy in patients undergoing heart transplantation.