Sert Doğan Emre, Kervan Ümit, Kocabeyoğlu Sinan Sabit, Karahan Mehmet, Küçüker Şeref Alp, Özatik Mehmet Ali, Paç Feyza Ayşenur, Paç Mustafa
Department of Cardiovascular Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Department of Pediatric Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Jan 23;28(1):120-126. doi: 10.5606/tgkdc.dergisi.2020.18586. eCollection 2020 Jan.
This study aims to investigate the effects of reoperative sternotomy on early and long-term outcomes after heart transplantation.
We retrospectively reviewed data of a total of 92 patients (72 males, 20 females; mean age 36 years; range, 3 to 61 years) who underwent orthotopic heart transplantation between May 1998 and July 2014. The patients were divided into three groups. Group A (n=23) included patients who underwent previous cardiac surgery with sternotomy other than ventricular assist device implantation; Group B (n=12) included patients who were bridged-to-transplant with a ventricular assist device; and Group C (n=57) included patients who for the first time underwent heart transplantation without previous sternotomy. Preoperative and operative data of the three groups were compared. The short- and long-term outcomes of all groups were analyzed.
There was no significant difference among the groups, except for the age and preoperative international normalized ratio. Total ischemia time in the ventricular assist device group was longer than Group C. The length of intensive care unit stay was also longer in the ventricular assist device group than the other groups. The amount of postoperative chest tube drainage and blood transfusion was higher in Group A. Early mortality rate was significantly higher in Group A. There was no significant difference in survival among the three groups in the long-term. According to the logistic regression analysis, no variable was found to be a significant risk factor for mortality.
Reoperative sternotomy other than ventricular assist device implantation was found to be a risk factor for early mortality; however, mid and long-term survival rates were similar to patients in whom transplantation was the primary procedure. In patients with reoperative sternotomy, heart transplantation can be performed with similar risks to patients without resternotomy with careful selection and accurate pre- and intraoperative surgical approach.
本研究旨在探讨再次胸骨切开术对心脏移植术后早期和长期预后的影响。
我们回顾性分析了1998年5月至2014年7月期间接受原位心脏移植的92例患者（72例男性，20例女性；平均年龄36岁；范围3至61岁）的数据。患者分为三组。A组（n = 23）包括曾接受除心室辅助装置植入以外的胸骨切开心脏手术的患者；B组（n = 12）包括使用心室辅助装置过渡到移植的患者；C组（n = 57）包括首次接受心脏移植且未进行过胸骨切开术的患者。比较三组的术前和手术数据。分析所有组的短期和长期预后。
除年龄和术前国际标准化比值外，各组之间无显著差异。心室辅助装置组的总缺血时间长于C组。心室辅助装置组的重症监护病房停留时间也比其他组长。A组术后胸管引流量和输血量更高。A组早期死亡率显著更高。长期来看，三组的生存率无显著差异。根据逻辑回归分析，未发现任何变量是死亡率的显著危险因素。
发现除心室辅助装置植入以外的再次胸骨切开术是早期死亡的危险因素；然而，中长期生存率与首次进行移植手术的患者相似。对于再次胸骨切开术的患者，经过仔细选择和准确的术前及术中手术方法，心脏移植的风险与未再次胸骨切开术的患者相似。
