Redo Heart Transplantation after Previous Cardiac Operations

Yun, Tae Jin; Park, Jung Jun; Choo, Suk Jung; Song, Hyun; Lee, Jae Won; Seo, Dong Man; Song, Meong Gun; Jang, Wan Sook; Kim, Young Hwue; Kim, Jae Joong

Abstract

PURPOSE: Heart transplantation on patients with previous cardiac operations has become more and more popular nowadays, and we assessed retrospectively the clinical features and surgical outcome of the patients who underwent redo heart transplantation after various cardiac operations.
METHODS
From November 1992 to June 2002, one hundred and six patients received heart transplantation, and, among them, 12 patients (11.3%), 7 men and 5 women, had had previous cardiac operations (Group I). Their age ranged from 14 years to 61 years (median: 36). Previous cardiac procedures were mitral valve surgery in 3, coronary artery bypass in 3, total correction of tetralogy of Fallot in 2, tricuspid valve surgery in 2, Aortic valve surgery in 1 and placement of left ventricular assist device (LVAD) in 1. Interval between primary operation to cardiac transplantation ranged from 18 months to 142 months (median: 78 months) when we exclude one patient who underwent transplantation 1 month after LVAD placement. HLA cross matching was done in all patients to rule out the presence of preformed anti-HLA antibody in recipients' sera. Postoperative follow-up duration was 423 patient-months (median 36 months), and intra- operative findings and postoperative outcome were compared with those of 94 patients who received cardiac transplantation as a primary operation (Group II).
RESULTS
There were no early and late mortality. Pre-bypass anesthetic time were longer in Group I (140 min) compared to Group II (100 min), and intra-operative events were more frequent in Group I (pre-bypass Hemodynamic instability in 5, Bleeding during reentry in 2, defibillation for ventricular fibrillation in 1, unplanned femoral cannulation in 1 and delayed sternal closure in 1. But there were no differences in bypass time, post-bypass anesthetic time, ventilatory support, ICU stay, hospital stay, inotropic support, chest tube drainage and transfusion amount between two groups. There was no space problem due to fibrotic and restrictive pericardial cavity in all but one patient, whose body weight was only 65% of donor body weight and pericardial cavity was relatively small. During the follow-up period, 3 patients (25%) experienced acute rejection necessitating steroid pulse therapy.
CONCLUSION
Redo heart trasplantation is more complicated procedure compared to primary cardiac transplantation, but early and intermediate term result is comparable to the latter. Space problem may ensue if pericardial cavity is small and Donor-Recipient body weight mismatch is great.