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J Thorac Cardiovasc Surg 1994;107:203-209
© 1994 Mosby, Inc.

CARDIAC AND PULMONARY TRANSPLANTATION

Heart transplantation in patients with previous cardiac operations:Excellent clinical results

Portland, Ore.

From The Oregon Cardiac Transplant Program, the Oregon Health Sciences University, Portland, Ore.

Received for publication Jan. 22, 1993. Accepted for publication May 17, 1993. Address for reprints: Gary Y. Ott, MD, Division of Cardiopulmonary Surgery, Mackenzie Hall L-353, 3181 SW Sam Jackson Park Rd., Portland, OR 97201.

Abstract

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 THORAC CARDIOVASC SURG 1994;107:203-9)

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