Previous thoracic surgery does not increase peri-operative mortality in pediatric heart-lung transplant recipients

Abstract

Background Heart-lung transplant (HLT) is indicated in select children with end-stage cardiopulmonary disease. We sought to determine whether previous thoracic surgery increases peri-operative morbidity and mortality. Methods Retrospective data were analyzed using unpaired Student’s t-test and Fisher’s exact test. Results are reported as mean ± SD. Peri-operative mortality was defined as death at ≤30 days post-transplant. Results From August 1993 through April 2001, 13 patients (mean age 7.9 ± 5.3 years; 9 girls, 4 boys) underwent HLT at our center. Eight of 13 (62%) had previous thoracic surgery and 5 of 13 (38%) did not. Interval of last surgery to transplant date was 45.5 ± 26.4 months (range 6 to 79 months). We compared HLT patients who had previous thoracic surgery to HLT recipients who did not. There was no significant difference in weight (18.6 ± 14.3 vs 36.5 ± 20.7 kg, p = 0.09), age (6.5 ± 4.5 vs 10.2 ± 6.1 years, p = 0.23) or duration of intubation (14.1 ± 12.9 vs 17.0 ± 30.3 days, p = 0.83). There were no caval or tracheal anastomotic stenoses in either group. There was no significant difference in blood products transfused ≤48 hours after HLT: packed red blood cells ( p = 0.16); fresh frozen plasma ( p = 0.13); platelets ( p = 0.59), and cryoprecipitate ( p = 0.27). There was no difference in cardiopulmonary bypass time (129.3 ± 48.2 vs 160.6 ± 73.9 minutes, p 0.39); post-operative diaphragm dysfunction (4 of 8 vs 0 of 5, p = 0.1); re-exploration for bleeding (2 of 8 vs 1 of 5, p = 1.0); or peri-operative mortality (2 of 8 vs 0 of 5, p = 0.48). Conclusions We conclude that previous thoracic surgery in HLT recipients does not significantly increase blood product transfusion, cardiopulmonary bypass time or peri-operative mortality.