Heart Transplantation With and Without Prior Sternotomy: Analysis of the United Network for Organ Sharing Database
| Autor: | Pranav Kansara, Francisco A. Arabia, M. Awad, Danny Ramzy, James Mirocha, Lawrence S.C. Czer, M. De Robertis, J. D. Moriguchi, Jon A. Kobashigawa, Fardad Esmailian, Robert M. Kass, Alfredo Trento |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Databases Factual medicine.medical_treatment computer.software_genre Risk Assessment chemistry.chemical_compound medicine Humans Dialysis Aged Proportional Hazards Models Heart Failure Heart transplantation Transplantation Creatinine Database business.industry Proportional hazards model Hazard ratio Middle Aged Sternotomy United States Confidence interval Surgery Treatment Outcome chemistry Multivariate Analysis Circulatory system Heart Transplantation Female Cardiomyopathies business computer |
| Zdroj: | Transplantation Proceedings. 46:249-255 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2013.09.027 |
| Popis: | Introduction. Patients with history of prior sternotomy may have poorer outcomes after heart transplantation. Quantitation of risk from prior sternotomy has not been well established. The United Network for Organ Sharing (UNOS) database was analyzed to assess early and late survival and predictors of outcome in adult heart transplant recipients with and without prior sternotomy. Methods. Of 11,266 adults with first hearteonly transplantation from 1997 to 2011, recipients were divided into 2 groups: those without prior sternotomy (first sternotomy group; n ¼ 6006 or 53.3%) and those with at least 1 prior sternotomy (redo sternotomy group; n ¼ 5260 or 46.7%). A multivariable Cox model was used to identify predictors of mortality. Results. Survival was lower in the redo group at 60 days (92.6% vs 95.9%; hazard ratio [HR] 1.83, 95% confidence interval [CI]: 1.56e2.15; P < .001). Conditional 5-year survival in 60-day survivors was similar in the 2 groups (HR ¼ 1.01, 95% CI 0.90e1.12, P ¼ .90). During the first 60 days post-transplant, the redo group had more cardiac reoperations (12.3% vs 8.8%, P ¼ .0008), a higher frequency of dialysis (8.9% vs 5.2%, P < .0001), a greater percentage of drug-treated infections (23.2% vs 19%, P ¼ .003), and a higher percentage of strokes (2.5% vs 1.4%, P ¼ .0001). A multivariable Cox proportional hazards model identified prior sternotomy as a significant independent predictor of mortality, in addition to age, female gender, congenital cardiomyopathy, need for ventilation, mechanical circulatory support, dialysis prior to transplant, pretransplant serum bilirubin (� 3 mg/dL), and preoperative serum creatinine (� 2 mg/dL). Conclusions. Prior sternotomy is associated with an excess 3.3% mortality and higher morbidity within the first 60 days after heart transplantation, as measured by frequency of dialysis, drug-treated infections, and strokes. Conditional 5-year survival after 60 days is unaffected by prior sternotomy. These findings should be taken into account for risk assessment of patients undergoing heart transplantation. |
| Databáze: | OpenAIRE |
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