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Reoperative sternotomy is associated with increased mortality after heart transplantation.

Publication ,  Journal Article
George, TJ; Beaty, CA; Ewald, GA; Russell, SD; Shah, AS; Conte, JV; Whitman, GJ; Silvestry, SC
Published in: Ann Thorac Surg
December 2012

BACKGROUND: Although several studies have examined factors affecting survival after orthotopic heart transplantation (OHT), few have evaluated the impact of reoperative sternotomy. We undertook this study to examine the incidence and impact of repeat sternotomies on OHT outcomes. METHODS: We conducted a retrospective review of all adult OHT from 2 institutions. Primary stratification was by the number of prior sternotomies. The primary outcome was survival. Secondary outcomes included blood product utilization and commonly encountered postoperative complications. Multivariable Cox proportional hazards regression models examined mortality while linear regression models examined blood utilization. RESULTS: From January 1995 to October 2011, 631 OHT were performed. Of these, 25 (4.0%) were redo OHT and 182 (28.8%) were bridged to transplant with a ventricular assist device; 356 (56.4%) had undergone at least 1 prior sternotomy. On unadjusted analysis, reoperative sternotomy was associated with decreased 90-day (98.5% vs 90.2%, p<0.001), 1-year (93.1% vs 79.6%, p<0.001), and 5-year (80.4% vs 70.1%, p=0.002) survival. This difference persisted on multivariable analysis at 90 days (hazard ratio [HR] 2.99, p=0.01), 1 year (HR 2.98, p=0.002), and 5 years (HR 1.62, p=0.049). The impact of an increasing number of prior sternotomies was negligible. On multivariable analysis, an increasing number of prior sternotomies was associated with increased intraoperative blood product utilization. Increasing blood utilization was associated with decreased 90-day, 1-year, and 5-year survival. CONCLUSIONS: Reoperative sternotomy is associated with increased mortality and blood utilization after OHT. Patients with more than 1 prior sternotomy do not experience additional increased mortality. Carefully selected patients with multiple prior sternotomies have decreased but acceptable outcomes.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2012

Volume

94

Issue

6

Start / End Page

2025 / 2032

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Sternotomy
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Middle Aged
 

Citation

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ICMJE
MLA
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George, T. J., Beaty, C. A., Ewald, G. A., Russell, S. D., Shah, A. S., Conte, J. V., … Silvestry, S. C. (2012). Reoperative sternotomy is associated with increased mortality after heart transplantation. Ann Thorac Surg, 94(6), 2025–2032. https://doi.org/10.1016/j.athoracsur.2012.07.039
George, Timothy J., Claude A. Beaty, Gregory A. Ewald, Stuart D. Russell, Ashish S. Shah, John V. Conte, Glenn J. Whitman, and Scott C. Silvestry. “Reoperative sternotomy is associated with increased mortality after heart transplantation.Ann Thorac Surg 94, no. 6 (December 2012): 2025–32. https://doi.org/10.1016/j.athoracsur.2012.07.039.
George TJ, Beaty CA, Ewald GA, Russell SD, Shah AS, Conte JV, et al. Reoperative sternotomy is associated with increased mortality after heart transplantation. Ann Thorac Surg. 2012 Dec;94(6):2025–32.
George, Timothy J., et al. “Reoperative sternotomy is associated with increased mortality after heart transplantation.Ann Thorac Surg, vol. 94, no. 6, Dec. 2012, pp. 2025–32. Pubmed, doi:10.1016/j.athoracsur.2012.07.039.
George TJ, Beaty CA, Ewald GA, Russell SD, Shah AS, Conte JV, Whitman GJ, Silvestry SC. Reoperative sternotomy is associated with increased mortality after heart transplantation. Ann Thorac Surg. 2012 Dec;94(6):2025–2032.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2012

Volume

94

Issue

6

Start / End Page

2025 / 2032

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Sternotomy
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Middle Aged