Our Summary

This research paper analyzes whether having a previous sternotomy (a surgical procedure in which a vertical incision is made along the sternum, allowing access to the heart) affects the outcome of a heart transplant. The researchers studied 512 adult patients who had heart transplants between 2000 and 2020 and categorized them into two groups: those who had a prior sternotomy and those for whom the heart transplant was their first sternotomy. They found that having a prior sternotomy did not increase the risk of death within 30 or 90 days of the transplant, nor did it predict any major postoperative complications. Therefore, they concluded that having a prior sternotomy does not represent a proper risk factor that might affect the outcomes of heart transplants. The complexity of the surgery may increase with a reoperation, but it does not significantly affect the patient’s health outcomes post-transplant.

FAQs

  1. Does a previous sternotomy increase the risk of death during a heart transplant?
  2. Does having a prior sternotomy predict any major postoperative complications after a heart-transplant?
  3. Does the complexity of a heart transplant surgery increase if the patient has had a previous sternotomy?

Doctor’s Tip

A doctor might tell a patient who has had a sternotomy in the past that having had this procedure should not significantly impact the outcome of a heart transplant. It is important to follow all post-operative care instructions and attend all follow-up appointments to ensure a successful recovery.

Suitable For

Patients who are recommended sternotomy are typically those who require access to the heart for surgical procedures such as heart transplants, coronary artery bypass surgery, valve replacement, and repair of congenital heart defects. Patients with a history of heart disease, heart failure, or other cardiac conditions that require surgical intervention may also be recommended sternotomy. Additionally, patients who have had previous sternotomies and require repeat cardiac surgery may undergo sternotomy as well.

Timeline

  • Before sternotomy:
  1. Patient undergoes pre-operative testing and evaluation to determine the need for a heart transplant.
  2. Patient is placed on a waiting list for a suitable donor heart.
  3. Patient receives notification of a suitable donor and prepares for the transplant surgery.
  4. Patient undergoes sternotomy surgery, where a vertical incision is made along the sternum to access the heart.
  5. Patient is placed on a heart-lung machine during the surgery to maintain blood circulation.
  6. Surgeon performs the heart transplant surgery, replacing the patient’s damaged heart with the donor heart.
  7. Patient is monitored closely in the intensive care unit post-surgery for any complications.
  • After sternotomy:
  1. Patient continues to be monitored in the hospital for signs of rejection or infection.
  2. Patient undergoes a rehabilitation program to regain strength and mobility post-surgery.
  3. Patient takes immunosuppressive medications to prevent rejection of the donor heart.
  4. Patient follows up with their transplant team regularly for monitoring and adjustments to medications.
  5. Patient gradually returns to normal activities and lifestyle, with ongoing support from their healthcare team.
  6. Patient may experience some physical limitations or complications due to the sternotomy surgery, but these are managed with appropriate care.

Overall, the patient’s journey before and after sternotomy for a heart transplant involves a series of critical steps to ensure a successful outcome and long-term health. The research findings suggest that having a prior sternotomy does not significantly impact the outcomes of heart transplants, providing reassurance to patients undergoing this life-saving procedure.

What to Ask Your Doctor

  1. How does having a previous sternotomy impact the surgical procedure for a heart transplant?
  2. Are there any specific risks or complications associated with a heart transplant in patients with a prior sternotomy?
  3. Will the presence of a prior sternotomy affect the recovery time or length of hospital stay after a heart transplant?
  4. Are there any additional precautions or considerations that need to be taken for patients with a previous sternotomy undergoing a heart transplant?
  5. How will having a previous sternotomy affect the long-term success and outcomes of a heart transplant?
  6. Are there any alternative treatment options or approaches that may be considered for patients with a prior sternotomy who require a heart transplant?
  7. What can I expect in terms of postoperative care and follow-up appointments after a heart transplant with a prior sternotomy?
  8. Will having a previous sternotomy impact my eligibility for a heart transplant or affect my chances of receiving a donor heart?
  9. Are there any specific factors or characteristics of my previous sternotomy that may be important to consider before undergoing a heart transplant?
  10. How common is it for patients with a prior sternotomy to undergo a heart transplant, and what is the overall success rate in this population?

Reference

Authors: Mariani C, Loforte A, Gliozzi G, Cavalli GG, Botta L, Martìn Suarez S, Potena L, Pacini D. Journal: J Card Surg. 2022 Apr;37(4):868-879. doi: 10.1111/jocs.16224. Epub 2022 Jan 14. PMID: 35032070