Our Summary

This research paper looks at the impact of previous chest surgery (specifically, an operation called a sternotomy) on heart transplant outcomes. The authors looked at medical records of heart transplant patients between 2012 and 2016, comparing those who had had a sternotomy before their transplant with those who hadn’t.

They found that patients who had undergone a sternotomy before their heart transplant were more likely to be older, male, have a higher body mass index, and have a specific type of heart disease known as ischemic cardiomyopathy. These patients also waited longer for their transplant.

Importantly, these patients were more likely to experience a condition called primary graft dysfunction (PGD) after their transplant. PGD is a serious condition where the new heart doesn’t function properly. They were also more likely to die within the first year after their transplant, and required more blood transfusions and had longer hospital stays.

The authors conclude that having a sternotomy before a heart transplant is a risk factor for developing PGD, and leads to worse outcomes after a transplant. They suggest that this information should be taken into account when making decisions about heart transplants.

FAQs

  1. What is the impact of a previous sternotomy on heart transplant outcomes?
  2. What is primary graft dysfunction (PGD) and how is it related to previous sternotomy?
  3. How does a previous sternotomy affect the patient’s condition post heart transplant?

Doctor’s Tip

A doctor might advise a patient who has had a sternotomy in the past to be aware of the increased risk of complications after a heart transplant, such as primary graft dysfunction. It is important for patients to closely follow their post-transplant care plan and to report any symptoms or concerns to their healthcare team promptly. Additionally, discussing this history with their transplant team can help ensure that they receive the appropriate monitoring and support to optimize their outcomes.

Suitable For

Patients who are typically recommended sternotomy include those who have undergone previous chest surgery, particularly those who have had a sternotomy. This may include patients with a history of heart surgery, such as coronary artery bypass grafting (CABG) or valve replacement surgery. Additionally, patients with certain types of heart disease, such as ischemic cardiomyopathy, may be recommended sternotomy before a heart transplant.

It is important for healthcare providers to carefully consider the potential risks and benefits of sternotomy in each individual patient, taking into account factors such as age, gender, body mass index, and overall health status. Patients who are at higher risk for complications after sternotomy, such as older patients or those with other medical conditions, may require closer monitoring and specialized care during and after the procedure.

Ultimately, the decision to recommend sternotomy before a heart transplant should be based on a thorough evaluation of the patient’s individual circumstances and the potential impact on their transplant outcomes.

Timeline

Before sternotomy:

  • Patient is diagnosed with heart disease and requires a heart transplant
  • Patient undergoes evaluation and is placed on the transplant waiting list
  • Patient may experience symptoms such as shortness of breath, chest pain, fatigue, and swelling
  • Patient may undergo various tests and procedures to assess their overall health and suitability for a transplant

After sternotomy:

  • Patient undergoes sternotomy surgery to access the heart for transplant
  • Patient may experience pain, discomfort, and limited mobility post-surgery
  • Patient is closely monitored for complications such as infection, bleeding, and pneumonia
  • Patient undergoes rehabilitation to regain strength and mobility
  • Patient may experience complications such as primary graft dysfunction (PGD) after their heart transplant
  • Patient may require additional medical interventions such as blood transfusions and longer hospital stays
  • Patient may have a higher risk of mortality within the first year after their transplant due to the impact of the sternotomy on transplant outcomes

Overall, the timeline for a patient before and after sternotomy involves a series of medical evaluations, procedures, and potential complications that can impact their overall health and outcomes following a heart transplant.

What to Ask Your Doctor

  1. What is a sternotomy and why might I need one before a heart transplant?
  2. How does having a previous sternotomy impact my risks and outcomes during and after a heart transplant?
  3. What specific complications or conditions should I be aware of if I’ve had a sternotomy before?
  4. Are there any additional precautions or treatments that should be considered due to my history of sternotomy?
  5. How will my recovery process be different compared to someone who hasn’t had a sternotomy before?
  6. Are there any specific lifestyle changes or activities I should avoid due to my previous sternotomy?
  7. What steps can be taken to minimize the risk of PGD or other complications after my heart transplant?
  8. Will having a sternotomy before a heart transplant affect my eligibility or priority for a transplant?
  9. Are there any alternative treatment options or considerations to take into account given my history of sternotomy?
  10. What long-term implications should I be aware of regarding my heart health and overall well-being after a heart transplant with a history of sternotomy?

Reference

Authors: Still S, Shaikh AF, Qin H, Felius J, Jamil AK, Saracino G, Chamogeorgakis T, Rafael AE, MacHannaford JC, Joseph SM, Hall SA, Gonzalez-Stawinski GV, Lima B. Journal: Interact Cardiovasc Thorac Surg. 2018 Sep 1;27(3):343-349. doi: 10.1093/icvts/ivy084. PMID: 29584854