The Persistent Influence of Prior Open-Heart Surgery on Early Outcomes After Pediatric Heart Transplantation

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.