HEART-TRANSPLANTATION IN PATIENTS WITH PREVIOUS CARDIAC OPERATIONS - EXCELLENT CLINICAL-RESULTS

A significant proportion of potential transplant recipients have under gone previous cardiac procedures and may be subject to an increased ri sk because of technical and other factors inherent in a reoperation. B etween December 1985 and June 1991, 155 orthotopic heart transplantati ons 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 nontra nsplant cardiac operations (group TT). Preoperative variables includin g hemodynamic indexes, renal function, and status on the waiting list were similar between these groups; however, group II patients tended t o be older than group I patients (51.9 +/- 10.7 versus 47.7 +/- 11.6 y ears, respectively; p < 0.05) and were more likely to have ischemic he art disease (80.3% versus 34.1%) than were those in group I. Significa ntly 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 8 7.1% +/- 3.6% and 72.9 % +/- 6.2%, respectively. Group D actuarial sur vival was 85.3% +/- 4.5% and 76.0% +/- 6.6%, respectively, for the sam e time periods. In spite of the greater technical challenge implied by previous cardiac operations, no significant survival differences occu rred between these groups (p > 0.9). However, patients undergoing a se cond cardiac transplantation (n = 9) were identified as a high-risk su bset with operative mortality of 22.8% and 1-year survival of only 33. 3% +/- 15.7% (p < 0.0003). Cardiac transplantation in patients who hav e undergone previous nontransplant cardiac operations can be carried o ut without compromising immediate or long-term outcome.