Doğan Emre SERT, Ümit KERVAN, Sinan Sabit KOCABEYOĞLU, Mehmet Gökhan KARAHAN, Şeref Alp KÜÇÜKER, Mehmet Ali ÖZATİK, Feyza AYŞENUR PAÇ, Mustafa PAÇ

Early and long-term results of heart transplantation with reoperative sternotomy

Background: This study aims to investigate the effects of reoperativesternotomy on early and long-term outcomes after heart transplantation.Methods: We retrospectively reviewed data of a total of 92 patients(72 males, 20 females; mean age 36 years; range, 3 to 61 years) whounderwent orthotopic heart transplantation between May 1998 andJuly 2014. The patients were divided into three groups. Group A(n=23) included patients who underwent previous cardiac surgery withsternotomy other than ventricular assist device implantation; Group B(n=12) included patients who were bridged-to-transplant with a ventricularassist device; and Group C (n=57) included patients who for the firsttime underwent heart transplantation without previous sternotomy.Preoperative and operative data of the three groups were compared. Theshort- and long-term outcomes of all groups were analyzed.Results: There was no significant difference among the groups, exceptfor the age and preoperative international normalized ratio. Totalischemia time in the ventricular assist device group was longer thanGroup C. The length of intensive care unit stay was also longer in theventricular assist device group than the other groups. The amount ofpostoperative chest tube drainage and blood transfusion was higher inGroup A. Early mortality rate was significantly higher in Group A.There was no significant difference in survival among the three groupsin the long-term. According to the logistic regression analysis, novariable was found to be a significant risk factor for mortality.Conclusion: Reoperative sternotomy other than ventricular assistdevice implantation was found to be a risk factor for early mortality;however, mid and long-term survival rates were similar to patients inwhom transplantation was the primary procedure. In patients withreoperative sternotomy, heart transplantation can be performed withsimilar risks to patients without resternotomy with careful selectionand accurate pre- and intraoperative surgical approach.

Reoperatif sternotomi ile kalp naklinin erken ve geç dönem sonuçları

Amaç: Bu çalışmada kalp nakli sonrasında reoperatif sternotominin erken ve geç dönem sonuçlar üzerine etkileri araştırıldı. Çalışma planı: Mayıs 1998 - Temmuz 2014 tarihleri arasında ortotopik kalp nakli yapılan toplam 92 hastanın (72 erkek, 20 kadın; ort. yaş 36; dağılım, 3-61 yaş) verileri retrospektif olarak incelendi. Hastalar üç gruba ayrıldı. Grup A (n=23) daha önce ventrikül destek cihaz implantasyonu hariç sternotomi ile kalp ameliyatı geçirmiş olan hastalardan; Grup B (n=12) ventrikül destek cihazı ile kalp nakline köprülenen hastalardan ve Grup C (n=57) daha önce sternotomi yapılmayan ve ilk kez kalp ameliyatı yapılan hastalardan oluşuyordu. Üç grubun ameliyat öncesi ve ameliyat verileri karşılaştırıldı. Tüm grupların kısa ve uzun dönem sonuçları incelendi. Bulgular: Gruplar arasında yaş ve ameliyat öncesi uluslararası normalleştirilmiş oran haricinde anlamlı bir fark yoktu. Toplam iskemi süresi, Grup C’ye kıyasla, ventrikül destek cihazı grubunda daha uzundu. Yoğun bakımda kalış süresi de, ventrikül destek cihazı grubunda diğer iki gruba kıyasla daha uzundu. Ameliyat sonrası göğüs tüpü drenaj ve kan transfüzyon miktarı, Grup A’da daha fazlaydı. Erken mortalite oranı Grup A’da anlamlı olarak daha yüksekti. Uzun dönemde üç grup arasında sağkalım açısından anlamlı bir fark yoktu. Lojistik regresyon analizine göre, değişkenlerin hiçbiri mortalitenin anlamlı bir risk faktörü değildi. Sonuç: Ventrikül destek cihaz implantasyonu haricinde reoperatif sternotomi, erken mortalitenin bir risk faktörü olarak bulundu; ancak orta ve uzun dönem sağkalım oranları, naklin ilk işlem olduğu hastalar ile benzerdi. Reoperatif sternotomi hastalarında kalp nakli titiz bir seçim ve doğru ameliyat öncesi ve ameliyat sırası cerrahi yaklaşım ile resternotomi yapılmayan hastalara benzer riskler ile gerçekleştirilebilir.

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