Objective
Previous cardiac operation has traditionally been considered as a potential risk factor
for patients undergoing heart transplantation. This study aimed to evaluate the outcome
of patients undergoing heart transplantation as a second cardiac procedure and compare
it with primary heart transplantation, using meta-analytical methodology.
Methods
A literature search was undertaken to identify relevant comparative studies. Outcomes
of interest were classified into four categories: (a) intra-operative times; (b) post-operative
outcomes; (c) resources; (d) actuarial outcomes.
Results
Seven studies matched the selection criteria, reporting on 1004 patients. Six hundred
and twenty-three had transplantation as primary operation and 381 as re-operation.
The 1-year, 2-year, and 5-year mortality were similar for the two groups (HR = 0.85, p = 0.54; HR = 0.97, p = 0.88; and HR = 1.04, p = 0.92, respectively). Total operative, cold-ischaemic, by-pass, and cross-clamp times
were significantly longer for the re-operation group by 59.44 (p < 0.001), 14.62 (p = 0.05), 25.24 (p < 0.001), and 7.93 (p < 0.001) min, respectively. Both ICU and hospital stay were longer for the re-operation group
but only the former was statistically significant (WMD = 1.37; p = 0.02). Post-operative complications were similar, except re-exploration rate and blood
transfusion requirement, which were higher in the re-operation group (OR = 3.51; p < 0.001 and WMD = 2.21; p < 0.001, respectively).
Conclusions
Heart transplantation following previous cardiac operation is technically demanding
requiring longer operative times compared to primary heart transplantation. It does
not, however, add a significant risk to the survival of the patient, and associated
morbidity is not significantly compromised.
Keywords
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Article info
Publication history
Accepted:
November 9,
2006
Received in revised form:
November 7,
2006
Received:
August 26,
2006
Identification
Copyright
© 2006 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
