Researchers at the Cedars Sinai Heart Institute in Los Angeles, California recently reported that the mortality and morbidity in patients who undergo heart transplantation can be increased by a prior surgical sternotomy. The study was published in the journal Transplantation Proceedings and is entitled “Prior Sternotomy Increases the Mortality and Morbidity of Adult Heart Transplantation.”
Heart transplantation is usually performed by an orthotopic approach, where a donor heart replaces the patient’s heart. Surgeons remove the recipient’s heart through sternotomy, a surgical incision made in the thorax along the sternum that provides access to the thoracic cavity, namely the heart and lungs.
This study focused on the analysis of the effects of prior sternotomy on the postoperative period of cardiac transplantation in terms of patient’s morbidity and mortality. A retrospective analysis was conducted in 704 patients who underwent orthotopic heart transplantation between December 1988 and June 2012 at Cedars Sinai Heart Institute. Of these patients, 345 had no previous sternotomy while 359 had one or more previous sternotomies. Patients were assessed for survival, hospital stays and frequency of required healthcare treatments.
Researchers found that both patient groups, with or without previous sternotomy, had a similar 60-day survival rate; however, the 1-year survival rate was found to be higher in transplant patients without previous sternotomy (94.7%) in comparison with patients with prior sternotomy (89.7%). It was also found that during surgery, patients with prior sternotomy had a longer pump time and required more blood transfusions, while after surgery, they remained longer in intensive care units (ICU) and hospitals, exhibited a higher frequency of postoperative reoperation for chest bleeding, sepsis and more than 48-hour ventilation in comparison with transplant patients without previous sternotomy. In addition, patients with two or more sternotomies were found to have a lower 60-day survival rate, longer intraoperative pump time and higher frequency of postoperative dialysis and pneumonia in comparison with those who had only one sternotomy.
The research team concluded that previous sternotomy decreases the survival rate of patients who undergo heart transplantation, while it increases intraoperative blood use, the postoperative period in ICUs and hospitals and the frequency of reoperation for bleeding. Prior sternotomy therefore increases the morbidity and mortality in patients after heart transplantation.