Abstract Objectives: This study aimed to evaluate the impact of prior open-heart surgery (PHS) on early mortality and morbidity following pediatric heart transplantation. Methods: We retrospectively analyzed 147 pediatric patients who underwent heart transplantation at our center between 1988 and 2024. Patients were divided into two groups: those with PHS (Group 1) and those without PHS (Group 2). The primary endpoint was mortality at 90 days and long-term follow-up. Secondary endpoints included total ischemic time and graft failure. Group differences were assessed using regression analysis. Results: Mean donor heart ischemic time was 235 ± 60 minutes in Group 1 and 234 ± 48 minutes in Group 2 (P = 0.451). The 90-day survival rate was 97% ± 2% in Group 1 and 99% ± 3% in Group 2 (P = 0.169). Long-term survival rates were 54% ± 8% and 69% ± 6% in Groups 1 and 2, respectively (P = 0.427). Retransplantation-free survival at long-term follow-up was 54% ± 9% in Group 1 and 57% ± 7% in Group 2 (P = 0.863). Univariable risk analysis showed no significant association between mortality and ischemic time (OR 1.00, 95% CI 0.99–1.01, P = 0.974), early graft failure (OR 0.29, 95% CI 0.06–1.36, P = 0.115), or use of post-transplant extracorporeal membrane oxygenation (ECMO) (OR 1.50, 95% CI 0.64–9.79, P = 0.187). Conclusions: Prior open-heart surgery was not associated with increased early or long-term graft failure after pediatric heart transplantation. Although patients without PHS had a non-significantly better survival rate, those with PHS experienced longer aortic cross-clamp times due to adhesions, ventricular assist device removal, or additional vascular repairs, resulting in prolonged operative times. Importantly, this did not translate into prolonged donor heart ischemic times.
Rosenthal et al. (Wed,) studied this question.
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