Early and long-term results of heart transplantation after previous cardiac surgery

Objectives: The aim of this study was to evaluate the preoperative management and long-term survival of patients undergoing heart transplantation as a redo-operation and compare the results with those obtained in patients undergoing transplantation as their first cardiac surgical procedure, Methods: Between 1990 and 1997, 49 heart transplantation procedures were performed in patients who had undergone previous cardiac surgery (group A). This subgroup of patients was compared to 109 control patients who underwent cardiac transplantation as the primary cardiac procedure (group B). Patient groups were analysed regarding their preoperative, intra-operative, and postoperative variables in addition to survival. Results: Pre-operative events were comparable in both groups but the duration of the operation was longer for group A (311 +/- 68 min) compared to group B (202 +/- 34 min); P = 0.02. Post-operative exploration for bleeding was 6/49 patients in group A compared to 2/107 patients in group B (P = 0.02). Post-operative blood loss and intensive care stay were greater for group A (1302 +/- 360 ml and 6.1 +/- 3.1 days, respectively) compared to group B (763 +/- 126 mi and 4.1 +/- 1.9 days, respectively); P = 0.02. There was no difference in hospital mortality (group A 12.5%, group B 13% P = 0.9) and the 5-year survival rates were 68 and 71% for group A and B, respectively (P = 0.9). Conclusions: Heart transplantation after previous open cardiac surgery is entirely justified in terms of outcome and graft function even in time of profound organ scarcity. Long-term events in these recipients are similar to patients in whom transplantation is the primary procedure. (C) 2000 Elsevier Science B.V. All rights reserved.