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

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Lily Rosenthal, Nikolaus A. Haas, Sebastian Michel, Carola Grinninger, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7325799/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Congenital Heart Disease Failed Heart Surgery Pediatric Cardiac Surgery Pediatric Heart Failure Prior Open-Heart Surgery Figures Figure 1 Introduction Limited data exist on how prior open-heart surgery affects outcomes after pediatric heart transplantation (HTx), despite many children requiring HTx having undergone such surgeries due to congenital heart disease (CHD) and prolonged donor wait times. Several studies have addressed related issues with varying focuses and results. Elahi et al. demonstrated that repeat median sternotomy can be safely performed with careful surgical technique, emphasizing the benefits of closing the pericardial sac during the initial surgery to reduce trauma ( 1 ). Similarly, O’Brien and colleagues found that prior surgery combined with direct surgical visualization reduces risks of cardiac injury and excessive bleeding post-transplant ( 2 ). n adult patients, Kansara et al. reported that previous open-heart surgery is associated with increased early morbidity and mortality after HTx ( 3 ). Regarding donor ischemic time (DIT), Morgan et al. found no negative impact of prolonged DIT on survival in pediatric patients, supporting the use of hearts with longer ischemic times to expand the donor pool ( 4 ). Conversely, Rodrigues et al. observed adverse effects linked to prolonged DIT after transplantation ( 5 ). Das et al. highlighted the importance of carefully balancing donor and recipient risk profiles when considering marginal donors, including those with low ejection fraction or extended ischemic times ( 6 ). Furthermore, Tissot and colleagues showed that pediatric patients requiring post-transplant extracorporeal membrane oxygenation (ECMO) tend to have longer ischemic times and are generally younger and smaller, complicating outcomes ( 7 ). Our previous work demonstrated that ventricular assist device (VAD) support prior to pediatric HTx did not increase neurological or operative complications during follow-up ( 8 ). Building on this, the current study focuses on the impact of prolonged ischemic time—particularly related to repeat open-heart surgery—on graft failure during the early post-transplant period. This study is especially relevant for pediatric cardiologists and cardiac surgeons as it addresses a critical knowledge gap regarding how prior open-heart surgeries affect transplantation outcomes in children. Given the complex surgical histories of many pediatric transplant patients, our findings offer reassuring evidence that prior surgeries do not significantly increase the risk of graft failure or mortality. This information is valuable for preoperative risk assessment, surgical planning, and counseling families about prognosis. By providing long-term survival data spanning over three decades, our work contributes meaningful evidence to improve clinical decision-making and ultimately enhance patient care in this challenging population. Since heart transplantation after prior open-heart surgery is technically more challenging—due to adhesions and possible concomitant repairs (see Image 1)—and early post-transplant outcomes may be worse, particularly within the first 90 days, this study aims to compare early results between patients with and without prior open-heart surgery. Additionally, we seek to identify strategies to minimize ischemic time and improve early survival. Patients and Methods Study Design Data Collection and Endpoints This retrospective study included 147 pediatric patients who underwent heart transplantation at our center between 1988 and 2024. Patients who received combined organ transplants (heart-kidney, heart-lung, heart-liver) or retransplantation were excluded. Demographic and clinical data, including operative notes and medical records, were retrieved from our institutional database. Follow-up information was collected during post-transplant outpatient clinic visits. The primary endpoint was mortality at 90 days and long-term follow-up. Secondary endpoints included duration of operative time, cardiopulmonary bypass (CPB) time, ischemic time, length of intensive care unit (ICU) stay, total hospital stay before and after transplantation, incidence of post-transplant bleeding, and freedom from sternal re-entry within 90 days post-transplant. Differences between groups were analyzed using regression analysis. Statistical Analysis Data were analyzed using IBM SPSS Statistics version 30 (Armonk, NY, USA). Continuous variables are presented as mean ± standard deviation or median with interquartile range (IQR), as appropriate. Categorical variables are expressed as frequencies and percentages. Fisher’s exact test was used for categorical variables, and appropriate parametric or non-parametric tests for continuous variables. A p-value ≤ 0.05 was considered statistically significant. Long-term survival was analyzed using Kaplan–Meier curves, with group differences evaluated by the log-rank test. Univariable logistic regression identified recipient risk factors for mortality; variables with p < 0.2 were entered into backward stepwise multivariable logistic regression. Cox proportional hazards regression was performed to identify independent predictors of long-term mortality. Odds ratios (OR) and hazard ratios (HR) are reported with 95% confidence intervals (CI). Results Sixty patients in Group 1 had one or more prior open-heart surgeries, whereas 87 patients in Group 2 underwent transplantation as their first open-heart surgery. Baseline demographics and clinical characteristics at transplantation are summarized in Table 1, including donor characteristics. All donor hearts were from brain-dead donors with adequate cardiac function confirmed by echocardiography prior to procurement. Intraoperative data showed significantly longer operative times in Group 1 (375 ± 95 minutes) compared to Group 2 (254 ± 48 minutes, p < 0.001). However, ischemic times were similar between groups (240 ± 58 minutes vs. 243 ± 48.5 minutes, p = 0.451). Total hospital stay was significantly longer in Group 1 (193 ± 88 days) than in Group 2 (122 ± 85 days, p = 0.003), while post-transplant hospital stay did not differ significantly (54 ± 7 days vs. 58 ± 7 days, p = 0.830). Congenital heart disease (CHD) diagnoses leading to transplantation in Group 1 included Norwood failure, Glenn failure, Fontan failure, Senning procedure failure in transposition of the great arteries (TGA), anomalous left coronary artery from the pulmonary artery (ALCAPA) repair failure, and Shone complex. In Group 2, CHD cases included hypoplastic left heart syndrome (HLHS) and tricuspid atresia. Additional procedures at transplantation included aortic arch enlargement (5 patients in Group 1, 9 in Group 2), superior vena cava reconstruction (5 in Group 1, 7 in Group 2), and pulmonary artery repair (11 in Group 1). Cardiomyopathy was the diagnosis at transplantation in 46 patients in Group 1 and 71 patients in Group 2. Among patients with Norwood failure, redo surgeries involved repeated Norwood procedures, shunt repairs or replacements, and aortic arch re-enlargements. Overall, 53% underwent one prior open-heart surgery, 20% two, 15% three, and 8% more than three. Additionally, 15% had more than three redo surgeries combined with ventricular assist device (VAD) implantation, while 25% had one redo surgery with VAD implantation. Central ECMO via median sternotomy was performed in 7 patients (12%), detailed in Table 2. The 30-day and 90-day survival are presented in Fig. 1 a and 1 b (Log-rank test: P = 0.350 and P = 0.169, respectively), showing no significant difference in risk between groups. Long-term survival at 30 years was better in Group 1, although not statistically significant (Log-rank test: P = 0.427). Retransplantation-free survival did not differ between groups (Figs. 1 c and 1 d). One child underwent retransplantation 27 days after the initial transplant and died 54 days post-transplant due to graft failure and multiorgan failure. Freedom from re-sternotomy at 90 days was 85% ± 5% in Group 1 and 78% ± 5% in Group 2. Early arrhythmias were observed more frequently in Group 2 but resolved by discharge. No significant difference was found in the rate of permanent pacemaker implantation within 90 days post-transplant. Ninety-day post-transplant outcomes are presented in Table 3. Univariable and multivariable Cox regression analyses for 90-day mortality (Table 4) showed no significant risk factors associated with mortality during this period. Discussion A major challenge in Germany is the shortage of donors, primarily because patients or their guardians must consent to organ donation before brain death is declared. Recent legislation in Germany has classified Donation after circulatory death (DCD) as illegitimate, which contrasts with practices in many European countries, Australia, and the USA where DCD is permitted ( 9 – 15 ). urgical reoperation is common in pediatric heart surgery, especially in children with complex congenital heart disease (CHD) ( 16 – 20 ). The preparation and timing of pediatric heart transplantation in patients with prior open-heart surgery, particularly those with single ventricle physiology, is crucial to optimize outcomes ( 21 ). Several authors have shown that transplantation in very young and small patients is significantly associated with mortality ( 22 ). In our cohort, 30-day and 90-day mortality rates were 4% in patients with prior open-heart surgery and 6% in patients without prior surgery; this difference was not statistically significant. Younger age at transplantation was also not identified as a risk factor for early mortality. At long-term follow-up (Fig. 3), survival rates were higher in patients with prior open-heart surgery at transplantation, although this difference was not statistically significant (P = 0.66). Graft survival at long-term follow-up (Fig. 4) was similar between groups (P = 0.292). Comparison of these figures showed no indication of graft failure in either early or long-term results. While waiting for a donor organ, more patients required ventricular assist device (VAD) support to stabilize their condition ( 23 ). Patients with Fontan failure often present with multiorgan dysfunction, protein-losing enteropathy, or plastic bronchitis. Previous reports have demonstrated the efficacy of subpulmonary VAD support as a bridge to transplantation in these patients ( 24 ). In our experience with a novel VAD cannula for subpulmonary support, functional and clinical status improved by the time of transplantation ( 25 ). Two patients with end-stage CHD due to failed Fontan circulation were supported with VADs, both surviving beyond three years post-transplant. Prior sternotomy has been identified as a risk factor for early graft failure ( 26 , 27 ). Tissot et al. reported that pediatric patients with prolonged donor ischemic time (DIT) had increased necessity for post-transplant ECMO support ( 7 ).However, comparing their data to ours was not feasible. In our study, ECMO use in the operating room or ICU was more frequent in patients with prior surgery (Group 1) (p = 0.047), but this was not due to prolonged DIT. Instead, the observed cardiac dysfunction was global and recovered within 24 to 48 hours. Hospital stay duration was not prolonged by post-ECMO support in Group 1. In one patient with Fontan failure, hemodynamic stabilization after superior vena cava and pulmonary artery stenting enabled ECMO weaning, delayed chest closure, and respiratory weaning. Univariable Cox analysis showed no statistically significant effect of pre-transplant VAD support on 90-day mortality (P = 0.585). Some authors have identified severe arrhythmias as markers of early graft dysfunction or failure; Mylonas et al. reported the necessity of pacemaker implantation early and late post-transplant as a sign of graft failure ( 28 ). In contrast, Mahmood et al. found pacemaker implantation after pediatric heart transplantation to be rare, with increasing donor age as the only risk factor for graft failure [25]. In contrast, Mahmood et al. found pacemaker implantation after pediatric heart transplantation to be rare, with increasing donor age as the only risk factor for graft failure ( 29 , 30 ). In our experience, patients exhibited initial cardiac arrhythmias in the early post-transplant period, including atrioventricular block and the need for external pacing. However, these conditions resolved within 90 days in the majority of cases. This study demonstrated that both early and long-term survival outcomes after pediatric heart transplantation are not significantly affected by a history of prior open-heart surgeries. Despite the increased technical complexity associated with multiple prior interventions, especially in patients with failed Fontan circulation, survival rates at 90 days and during long-term follow-up were comparable to those undergoing primary transplantation. These results suggest that, in experienced centers, repeated sternotomies and prior cardiac surgeries should not be considered absolute contraindications to transplantation. Our findings align with previous studies reporting similar post-transplant outcomes in patients with complex congenital heart disease, underscoring the importance of tailored perioperative planning and surgical expertise. Limitations The heterogeneity of the patient cohort—particularly regarding age, duration of follow-up, indication for heart transplantation, and the number of prior open-heart surgeries—poses challenges for direct comparison of outcomes across groups. These differences underscore the need for future multicenter studies that standardize patient populations, age ranges, and follow-up protocols. Such efforts will enhance the accuracy of comparisons and deepen our understanding of long-term survival and quality of life following pediatric heart transplantation, ultimately enabling more personalized care strategies. Conclusion Prior open-heart surgery does not increase the risk of graft failure in either early or long-term follow-up. Although patients without previous heart surgery showed a trend toward better survival, this difference was not statistically significant. Patients with prior open-heart surgery experienced longer aortic cross-clamp times due to adhesions, ventricular assist device (VAD) explantation, or additional cardiac repairs (e.g., aorta, superior vena cava, pulmonary arteries), resulting in extended operative times. Importantly, these factors did not lead to prolonged donor ischemic time (DIT). Abbreviations ALCAPA: Anomalous left coronary artery from the pulmonary artery. ASD: Atrial septal defect. BMI: Body Mass Index. BVAD: Bi-ventricular assist device. CHD: Congenital heart disease. ECMO/ECLS – Extracorporeal membrane oxygenation / Extracorporeal life support. CI: Confidence interval. CMP: Cardiomyopathy. CPB: Cardiopulmonary bypass. DCD: Donation after circulatory death. DIT: Donor ischemic time. HLHS: Hypoplastic left heart syndrome. HTx: Heart transplantation. ICU: Intensive care unit. IQR: Interquartile range. LVAD: Left ventricular assist device. PHS: Prior open-heart surgery. OR: Odd ratio, RV: Right ventricle. RVAD: Right ventricular assist device. TGA: Transposition of the great arteries. VAD: Ventricular assist device. USA: United State of Amerika. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the [Ethics Committee of Ludwig Maximilians University of Munich] (Approval number: 752-15). Informed consent was obtained from all participants or their legal guardians. Human Ethics and Consent to Participate declarations: Not applicable. Clinical trial number: Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding There is no conflict of interest for any of the authors regarding this report. Authors' contributions LLR (L. Lily Rosenthal) contributed to design, performed the literature review, acquisition of data, interpretation, writing and editing the paper. All co-authors contributed to the design and interpretation of data. Acknowledgements We are grateful to Dr. Alexander Crispin (Institute for Medical Information Processing, Biometry and Epidemiology; IBE of the Ludwig-Maximilian-University, Munich) for his statistical assistance with this report. We also like to thank Mrs. Anne Wölffel-Gale for her invaluable editorial assistance in preparing our report. References Elahi MM, Kirke R, Lee D, Dhannapuneni RR, Hickey MS. The complications of repeat median sternotomy in paediatrics: six-months follow-up of consecutive cases. Interact Cardiovasc Thorac Surg. 2005;4(4):356–9. O'Brien MF, Harrocks S, Clarke A, Garlick B, Barnett AG. How to do safe sternal reentry and the risk factors of redo cardiac surgery: a 21-year review with zero major cardiac injury. J Card Surg. 2002;17(1):4–13. Kansara P, Czer L, Awad M, Arabia F, Mirocha J, De Robertis M et al. Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database. Transplantation proceedings. 2014;46(1):249 – 55. Morgan JA, John R, Park Y, Addonizio LJ, Oz MC, Edwards NM, et al. Successful outcome with extended allograft ischemic time in pediatric heart transplantation. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2005;24(1):58–62. Rodrigues W, Carr M, Ridout D, Carter K, Hulme SL, Simmonds J et al. Total donor ischemic time: relationship to early hemodynamics and intensive care morbidity in pediatric cardiac transplant recipients. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2011;12(6):660-6. Das B, Trivedi JR, Sinha P, Ramakrishnan K, Alsoufi B, Deshpande SR. Interplay between donor and recipient factors impacts outcomes after pediatric heart transplantation: An analysis from the united network for organ sharing database. Pediatr Transplant. 2021;25(3):e13912. Tissot C, Buckvold S, Phelps CM, Ivy DD, Campbell DN, Mitchell MB, et al. Outcome of extracorporeal membrane oxygenation for early primary graft failure after pediatric heart transplantation. J Am Coll Cardiol. 2009;54(8):730–7. Rosenthal LL, Grinninger C, Ulrich SM, Dalla Pozza R, Haas NA, Brenner P, et al. The impact of pre-transplant ventricular assist device support in pediatric patients with end-stage heart failure on the outcomes of heart transplantation-a single center experience. Front Cardiovasc Med. 2025;12:1515218. Kwon JH, Usry B, Hashmi ZA, Bhandari K, Carnicelli AP, Tedford RJ, et al. Donor utilization in heart transplant with donation after circulatory death in the United States. Am J transplantation: official J Am Soc Transplantation Am Soc Transpl Surg. 2024;24(1):70–8. Thiessen C, Gordon EJ, Kelly B, Wall A. The ethics of donation after circulatory death organ recovery: an overview of new considerations arising from procurement practice and policy changes. Curr Opin Organ Transplant. 2023;28(2):133–8. Siddiqi HK, Trahanas J, Xu M, Wells Q, Farber-Eger E, Pasrija C, et al. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol. 2023;82(15):1512–20. Lyle MA, English SW, Goswami RM, Leoni Moreno JC, Nativi-Nicolau J, Yip DS, et al. Donation after circulatory death: A transplant cardiologist's take on neuroprognostication. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2023;42(10):1481–3. Alomari M, Garg P, Yazji JH, Wadiwala IJ, Alamouti-Fard E, Hussain MWA, et al. Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant? Cureus. 2022;14(6):e26281. Koscik R, Ngai J. Donation After Circulatory Death: Expanding Heart Transplants. J Cardiothorac Vasc Anesth. 2022;36(10):3867–76. Jawitz OK, Raman V, DeVore AD, Mentz RJ, Patel CB, Rogers J, et al. Increasing the United States heart transplant donor pool with donation after circulatory death. J Thorac Cardiovasc Surg. 2020;159(5):e307–9. Alsoufi BMW, Manlhiot C, Deshpande S, Kogon B, McCrindle BW, Kanter K. Outcomes of heart transplantation in children with hypoplastic left heart syndrome previously palliated with the Norwood procedure. J Thorac Cardiovasc Surg. 2015;Sep 28.:pii: S0022-5223(15)01790-0. Alsoufi B, Deshpande S, McCracken C, Kogon B, Vincent R, Mahle W, et al. Outcomes and risk factors for heart transplantation in children with congenital heart disease. J Thorac Cardiovasc Surg. 2015;150(6):1455–e623. Everitt MD, Boyle GJ, Schechtman KB, Zheng J, Bullock EA, Kaza AK, et al. Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a multi-institutional study. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2012;31(5):509–16. Ruygrok PN. Transplantation: the final hurdle to longevity in patients with congenital heart disease. Heart. 2019;105(8):582–3. Dimopoulos K, Muthiah K, Alonso-Gonzalez R, Banner NR, Wort SJ, Swan L, et al. Heart or heart-lung transplantation for patients with congenital heart disease in England. Heart. 2019;105(8):596–602. Fynn-Thompson F. Heart Transplantation in Adults with Congenital Heart Disease. Methodist Debakey Cardiovasc J. 2019;15(2):145–8. Rizwan R, Zafar F, Chin C, Tweddell J, Bryant R 3. rd, Morales D. Listing Low-Weight or Ill Infants for Heart Transplantation: Is It Prudent? The Annals of thoracic surgery. 2018;106(4):1189–96. Mariani C, Loforte A, Gliozzi G, Cavalli GG, Botta L, Martìn Suarez S, et al. Impact of prior sternotomy on survival and allograft function after heart transplantation: A single center matched analysis. J Card Surg. 2022;37(4):868–79. Prêtre R, Häussler A, Bettex D, Genoni M. Right-sided univentricular cardiac assistance in a failing Fontan circulation. Ann Thorac Surg. 2008;86(3):1018–20. Michel SG, Menon AK, Haas NA, Hörer J. Cavopulmonary support with a modified cannulation technique in a failing Fontan patient. Interact Cardiovasc Thorac Surg. 2022;35(2). Still S, Shaikh AF, Qin H, Felius J, Jamil AK, Saracino G, et al. Reoperative sternotomy is associated with primary graft dysfunction following heart transplantation. Interact Cardiovasc Thorac Surg. 2018;27(3):343–9. Singh NM, Loomba RS, Kovach JR, Kindel SJ. Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease. Cardiol Young. 2019;29(5):667–71. Mylonas KS, Repanas T, Athanasiadis DI, Voulgaridou A, Sfyridis PG, Bakoyiannis C, et al. Permanent pacemaker implantation in pediatric heart transplant recipients: A systematic review and evidence quality assessment. Pediatr Transplant. 2020;24(3):e13698. Mahmood A, Andrews R, Fenton M, Morrison A, Mangat J, Davies B, et al. Permanent pacemaker implantation after pediatric heart transplantation: Risk factors, indications, and outcomes. Clin Transplant. 2019;33(4):e13503. Rosenthal LL, Grinninger C, Pozza RD, Fischer M, Zimmerling L, Ulrich SM, et al. Impact of the operative technique on mid- and long-term results following paediatric heart transplantation. ESC heart failure; 2024. Tables Table 1: Demographic and clinical data of recipients and donors at the time of transplantation. Prior open-heart surgery Group 1, 60 (42%) No open-heart surgery Group 2, 87 (58%) All N = 147 P-value Recipient’s demographic and clinical baseline data Age (y), mean ± SD (range) 8±6 (32) 9±7 (18) 9±7 (32) 0.477 Age groups (years) 6-12 (n=26) >12 (n=60) 12 (20%) 14 (23%) 10 (17%) 24 (40%) 28 (32%) 6 (7%) 16 (18%) 37 (23%) 40 (27%) 20 (13%) 26 (18%) 61 (41%) 0.094 Gender (male) 31 (65%) 49 (56%) 80 (55%) 0.611 Weight (kg) mean ± SD (range) 28.9 ± 22 (77) 29 ± 23 (74) 29 ± 22 (77) 0.441 BMI (kg/m 2 ), mean ± SD (range) 16 ± 4 (16) 16 ± 3 (17) 16 ± 4 (17) 0.749 Waiting time on list for transplantation (days) mean ± SD (range) 189 ± 146 (852) 129 ± 70 (852) 158 ± 100 (971) 0.013 ECMO/ECLS implantation 7 (12%) 0 7 (5%) 0.002 CHD HLHS/hypoplastic RV Norwood failure Glenn failure Fontan failure Senning failure by TGA ALCAPA repair failure Congenital valve stenosis 16 (23%) 0 2 (3%) 3 (5%) 4 (6%) 3 (5%) 1 (1%) 3 (5%) 13 (14%) 28 (19%) 13 (9%) 1 (1%) 3 (2%) 4 (3%) 3 (2%) 1 (1%) 3 (2%) 0.057 CMP DCM Restrictive CMP Hypertrophic CMP Non-compaction CMP Ischemic CMP Toxic CMP Myocarditis Carvajal syndrome Kawasaki syndrome 44 26 (43%) 1 (2%) 2 (2%) 6 (10%) 0 1 (2%) 7 (12%) 0 1 (2%) 75 61 (70%) 3 (3%) 3 (3%) 2 (2%) 1 (1%) 1 (1%) 1 (1%) 2 (2%) 1 (1%) 119 (81%) 87 (59%) 4 (3%) 5 (4%) 8 (6%) 1 (1%) 2 (1%) 8 (6%) 2 (1%) 2 (1%) Donor’s demographic and clinical baseline data Gender (male) 33 (55%) 46 (53%) 79 (54%) 0.867 Age (y), mean ± SD (range) 15 ± 14 (52) 15 ± 14 (57) 14 ± 13 (57) 0.432 Weight (kg), mean ± SD (range) 38 ± 26 (94) 35 ± 25 (93) 36 ± 26 (97) 0.873 Donor- BMI (kg/m 2 ), mean ± SD (range) 18 ± 6 (28) 18 ± 4 (17) 18 ± 5 (28) 0.916 Perioperative Data Organ preservation solution HTK UW2 Celsior ® 37 (61%) 23 (38%) 0 27 (30%) 56 ((64%) 4 (5%) 64 (42%) 79 (55%) 4 (3%) 0.001 Ischemic time - donor (minutes), mean ± SD (range) 235 ± 60 (285) 234 ± 48 (229) 254 ± 53 (285) 0.451 Skin-to-skin (minutes), mean ± SD (range) 372 ± 107 (588) 253 ± 48 (232) 301 ± 97 (588) <0.001 CPB time (minutes), mean ± SD (range) 191 ±65 (209) 189 ± 65 (232) 190 ± 55 (232) 0.846 Aortic cross clamp-time (minutes), mean ± SD (range) 88 ± 29 (157) 75 ± 25 (168) 81 ± 28 (178) 0.001 Post transplant ECMO/ ECLS implantation 25 (17%) 0.050 Delayed chest closure 14 ((23%) 11 (13%) 24 (17%) 0.188 Length of ventilation support (hours) 50 17 (28%) 11 (18%) 24 (40%) 9 (15%) 39 (45%) 18 (21%) 21 (24%) 9 (10%) 33 ± 28 56 (38%) 29 (20%) 45 (31%) 16 (11%) 0.324 ICU-Stay (days), mean ± SD (range) 29 ± 27 (164) 87 ± 34 (737) 69 ± 31 (738) 0.968 Hospital-length (days), mean ± SD (range) 191 ± 185 (916) 127 ± 93 (474) 151 ± 142 (942) 0.003 Hospital-stay after HTx (days), mean ± SD (range) 50 ± 45 (916) 101 ± 66 (768) 56 ± 83 (810) 0.912 Continuous variables are presented as mean ± standard deviation (range) and were analyzed using a t -test. Categorical variables (n, %) were analyzed using crosstabulations (chi-square test). A two-sided p -value ≤ 0.05 was considered statistically significant. Table 2: Number of prior open-heart surgeries and types of procedures performed. Previous open-heart surgery 60 (41%) Number of previous surgeries* Only 1 32 (22%) 2 10 (7%) 3 9 (6%) > 3 9 (6%) Failed procedures + ECMO 1 (2%) Failed procedures + VAD 5 (4%) ECMO to VAD 6 (4%) VAD 34 (26) Type of failed procedures* Norwood , shunt repair 2 (1%) Norwood, Shunt repair, Gle nn 3 (2%) Norwood, Shunt repair, Gle nn , Fontan, Valve replacement 4 (3%) PA Banding 2 (1%) ASD enlargement / ASD Closure 1 (1%) ALCAPA repair 1 (1%) Failed Senning 3 (2%) Aortic valve and mitral valve repair 3 (2%) Failed Ross procedure and CBAG 1 (1%) Central ECMO/ ECLS Support 7 (5%) VAD implantation 44 (30%) LVAD 3 37 (25%) BVAD 4 6 (4%) RVAD 5 1 (1%) *More than one type of previous heart surgery is possible. Categorical variables were analyzed using crosstabulations (Chi-square test). Abbreviations: ASD, atrial septal defect; ALCAPA, anomalous left coronary artery from the pulmonary artery; ¹only ventricular assist device support; ²only central ECMO/ECLS (veno-arterial), extracorporeal membrane oxygenation/extracorporeal life support; ³LVAD, left ventricular assist device; ⁴BVAD, bi-ventricular assist device; ⁵RVAD, right ventricular assist device. Table 3: Clinical outcomes at 90 days following pediatric heart transplantation. Redo open-heart surgery Group 1, 60 (42%) First open-heart surgery Group 2, 87 (58%) All N = 147 P-value ECMO/ECLS implantation 16 (27%) 12 (14%) 28 (19%) 0.057 Delated chest closure 14 (23%) 11 (13%) 24 (17%) 0.118 Renal dysfunction 19 (32%) 40 (46%) 59 (40%) 0.090 Dialysis 13 (22%) 26 (30%) 39 (27%) 0.342 Cardiac arrythmia 26 (43%) 50 (58%) 76 (52%) 0.064 Pacemaker implantation 3 (5%) 3 (3%) 6 (4%) 0.147 Wound dehiscent 10 (16%) 13 (15%) 23 (16%) 0.075 Wound revision 7 (12%) 16 (18%) 15 (10%) 0.357 Bleeding 23 (38%) 31 (36%) 54 (37%) 0.862 Effusion 17 (28%) 32 (37%) 49 (33%) 0.374 Resternotomy (bleeding or pericardial effusion) 10 (17%) 18 (21%) 16 (11%) 0.670 Diaphragm paresis 4 (7%) 6 (7%) 10 (7%) 0.390 Early graft failure 16 (27%) 11 (14%) 26 (18%) 0.050 Late graft failure 19 (32%) 36 (41%) 54 (37%) 0.298 Categorical variables, expressed as counts and percentages (n; %), were analyzed using crosstabulations (chi-square test). A p-value ≤ 0.05 was considered statistically significant. Abbreviations: ECMO/ECLS –Extracorporeal Membrane Oxygenation / Extracorporeal Life Support; HTx – Heart Transplantation. Table 4: Univariable Cox proportional hazards analysis of risk factors associated with 90-day mortality. Univariable Cox analysis OR (95% CI) p-value Recipient Age (per years) 1.016 (0.922-1.120) 0.744 Gender 0.535 (0.138-2.071) 0.365 Body weight (per kg) 1.008 (0.981-1.035) 0.583 BMI (per kg/cm 2 ) 1.013 (0.857-1.198) 0.877 Indication for HTX 2.926 (0.722-11.867) 0.133 Pre- HTx ECLS / ECMO 0.000 (0.000-) 0.985 Pre- HTx VAD Support 0.462 (0.029-7.380) 0.585 Waiting on the list (per days) 0.999 (0.993-1.005) 0.683 Donor Age (per years) 1.008 (0.968-1.050) 0.701 Gender 0.275 (0.058-1.296) 0.103 Body weight (per kg) 1.013 (0.988-1.038) 0.304 BMI (kg/cm 2 ) 1.109 (0.973-1.263) 0.12 Postoperative Early / primary graft failure 0.285 (0.060-1.359) 0.115 ECLS/ECMO support 2.503 (0.640-9.790) 0.187 Bleeding 1.196 (0.337-4.238) 0.782 Effusion 0.197 (0.025-1.563) 0.124 Redo sternotomy 1.059 (0.224-5.000) 0.943 Renal dysfunction 1.000 (0.281-3.553) 0.999 Dialysis 0.632 (0.145-3.229) 0.632 Cardiac arrhythmia 0.331 (0.085-1.292) 0.111 Pacemaker implantation 1.331 (0.280-6.334) 0.719 Neurological (infarction /bleeding) 0.343 (0.073-1.616) 0.176 Organ preservation solution 6.068 (0.750-49.121) 0.091 Ischemic time per minutes 1.000 (0.988-1.013) 0.974 Aortic clamp time per minutes 1.017 (1.000-1.034) 0.052 CPB time (minutes) 1.007 (0.993-1.016) 0.118 Skin-to-skin (minutes) 0.997 (0.986-1.008) 0.554 Abbreviations: BMI: Body Mass Index; HTx: Heart Transplantation; ECMO/ECLS: Extracorporeal Membrane Oxygenation / Extracorporeal Life Support; VAD: Ventricular Assist Device; CPB: Cardiopulmonary Bypass Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7325799","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515533256,"identity":"af56146d-c8a4-4e8e-b3e0-67266ff633ee","order_by":0,"name":"L. Lily Rosenthal","email":"data:image/png;base64,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","orcid":"","institution":"LMU University","correspondingAuthor":true,"prefix":"","firstName":"L.","middleName":"Lily","lastName":"Rosenthal","suffix":""},{"id":515533257,"identity":"229f5dd2-0525-4071-badc-3d75fef87f05","order_by":1,"name":"Nikolaus A. Haas","email":"","orcid":"","institution":"LMU University","correspondingAuthor":false,"prefix":"","firstName":"Nikolaus","middleName":"A.","lastName":"Haas","suffix":""},{"id":515533258,"identity":"12154d61-f849-40ee-b1a5-c723424d9168","order_by":2,"name":"Sebastian Michel","email":"","orcid":"","institution":"LMU University","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Michel","suffix":""},{"id":515533259,"identity":"f2241e91-f824-48d7-90f1-7dff158c1e0a","order_by":3,"name":"Carola Grinninger","email":"","orcid":"","institution":"LMU University","correspondingAuthor":false,"prefix":"","firstName":"Carola","middleName":"","lastName":"Grinninger","suffix":""},{"id":515533260,"identity":"bb4e9cef-2994-4e65-ad86-be8cf720757b","order_by":4,"name":"Jürgen Hörer","email":"","orcid":"","institution":"LMU University","correspondingAuthor":false,"prefix":"","firstName":"Jürgen","middleName":"","lastName":"Hörer","suffix":""},{"id":515533261,"identity":"d19619b6-9d21-4a81-ab11-7937f1e7dece","order_by":5,"name":"Christian Hagl","email":"","orcid":"","institution":"LMU University","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Hagl","suffix":""}],"badges":[],"createdAt":"2025-08-08 09:38:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7325799/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7325799/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91561371,"identity":"f01a3b07-d1a6-4128-b290-0217a5626110","added_by":"auto","created_at":"2025-09-17 18:47:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":661352,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea and b\u003c/strong\u003e: The 30-day and 90-day survival in each group (Long-rank test: P = 0.350 and P = 0.169).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec and d:\u003c/strong\u003eLong-term survival at 30-year was and retransplantation-free survival between each group.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7325799/v1/c70914029749a2a31fa9eb4f.png"},{"id":105365277,"identity":"e20e725d-9672-4900-ba63-3ca90caebf16","added_by":"auto","created_at":"2026-03-25 08:29:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1418411,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7325799/v1/297dbbb1-975b-4354-9dc6-d41365da1da3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Persistent Influence of Prior Open-Heart Surgery on Early Outcomes After Pediatric Heart Transplantation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLimited data exist on how prior open-heart surgery affects outcomes after pediatric heart transplantation (HTx), despite many children requiring HTx having undergone such surgeries due to congenital heart disease (CHD) and prolonged donor wait times. Several studies have addressed related issues with varying focuses and results. Elahi et al. demonstrated that repeat median sternotomy can be safely performed with careful surgical technique, emphasizing the benefits of closing the pericardial sac during the initial surgery to reduce trauma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Similarly, O\u0026rsquo;Brien and colleagues found that prior surgery combined with direct surgical visualization reduces risks of cardiac injury and excessive bleeding post-transplant (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). n adult patients, Kansara et al. reported that previous open-heart surgery is associated with increased early morbidity and mortality after HTx (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Regarding donor ischemic time (DIT), Morgan et al. found no negative impact of prolonged DIT on survival in pediatric patients, supporting the use of hearts with longer ischemic times to expand the donor pool (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Conversely, Rodrigues et al. observed adverse effects linked to prolonged DIT after transplantation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Das et al. highlighted the importance of carefully balancing donor and recipient risk profiles when considering marginal donors, including those with low ejection fraction or extended ischemic times (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, Tissot and colleagues showed that pediatric patients requiring post-transplant extracorporeal membrane oxygenation (ECMO) tend to have longer ischemic times and are generally younger and smaller, complicating outcomes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur previous work demonstrated that ventricular assist device (VAD) support prior to pediatric HTx did not increase neurological or operative complications during follow-up (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Building on this, the current study focuses on the impact of prolonged ischemic time\u0026mdash;particularly related to repeat open-heart surgery\u0026mdash;on graft failure during the early post-transplant period. This study is especially relevant for pediatric cardiologists and cardiac surgeons as it addresses a critical knowledge gap regarding how prior open-heart surgeries affect transplantation outcomes in children. Given the complex surgical histories of many pediatric transplant patients, our findings offer reassuring evidence that prior surgeries do not significantly increase the risk of graft failure or mortality. This information is valuable for preoperative risk assessment, surgical planning, and counseling families about prognosis.\u003c/p\u003e\u003cp\u003eBy providing long-term survival data spanning over three decades, our work contributes meaningful evidence to improve clinical decision-making and ultimately enhance patient care in this challenging population. Since heart transplantation after prior open-heart surgery is technically more challenging\u0026mdash;due to adhesions and possible concomitant repairs (see Image 1)\u0026mdash;and early post-transplant outcomes may be worse, particularly within the first 90 days, this study aims to compare early results between patients with and without prior open-heart surgery. Additionally, we seek to identify strategies to minimize ischemic time and improve early survival.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eData Collection and Endpoints\u003c/h2\u003e\u003cp\u003eThis retrospective study included 147 pediatric patients who underwent heart transplantation at our center between 1988 and 2024. Patients who received combined organ transplants (heart-kidney, heart-lung, heart-liver) or retransplantation were excluded. Demographic and clinical data, including operative notes and medical records, were retrieved from our institutional database. Follow-up information was collected during post-transplant outpatient clinic visits. The primary endpoint was mortality at 90 days and long-term follow-up. Secondary endpoints included duration of operative time, cardiopulmonary bypass (CPB) time, ischemic time, length of intensive care unit (ICU) stay, total hospital stay before and after transplantation, incidence of post-transplant bleeding, and freedom from sternal re-entry within 90 days post-transplant. Differences between groups were analyzed using regression analysis.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using IBM SPSS Statistics version 30 (Armonk, NY, USA). Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median with interquartile range (IQR), as appropriate. Categorical variables are expressed as frequencies and percentages. Fisher\u0026rsquo;s exact test was used for categorical variables, and appropriate parametric or non-parametric tests for continuous variables. A p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant. Long-term survival was analyzed using Kaplan\u0026ndash;Meier curves, with group differences evaluated by the log-rank test. Univariable logistic regression identified recipient risk factors for mortality; variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were entered into backward stepwise multivariable logistic regression. Cox proportional hazards regression was performed to identify independent predictors of long-term mortality. Odds ratios (OR) and hazard ratios (HR) are reported with 95% confidence intervals (CI).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSixty patients in Group 1 had one or more prior open-heart surgeries, whereas 87 patients in Group 2 underwent transplantation as their first open-heart surgery. Baseline demographics and clinical characteristics at transplantation are summarized in Table\u0026nbsp;1, including donor characteristics. All donor hearts were from brain-dead donors with adequate cardiac function confirmed by echocardiography prior to procurement.\u003c/p\u003e\n\u003cp\u003eIntraoperative data showed significantly longer operative times in Group 1 (375\u0026thinsp;\u0026plusmn;\u0026thinsp;95 minutes) compared to Group 2 (254\u0026thinsp;\u0026plusmn;\u0026thinsp;48 minutes, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, ischemic times were similar between groups (240\u0026thinsp;\u0026plusmn;\u0026thinsp;58 minutes vs. 243\u0026thinsp;\u0026plusmn;\u0026thinsp;48.5 minutes, p\u0026thinsp;=\u0026thinsp;0.451). Total hospital stay was significantly longer in Group 1 (193\u0026thinsp;\u0026plusmn;\u0026thinsp;88 days) than in Group 2 (122\u0026thinsp;\u0026plusmn;\u0026thinsp;85 days, p\u0026thinsp;=\u0026thinsp;0.003), while post-transplant hospital stay did not differ significantly (54\u0026thinsp;\u0026plusmn;\u0026thinsp;7 days vs. 58\u0026thinsp;\u0026plusmn;\u0026thinsp;7 days, p\u0026thinsp;=\u0026thinsp;0.830).\u003c/p\u003e\n\u003cp\u003eCongenital heart disease (CHD) diagnoses leading to transplantation in Group 1 included Norwood failure, Glenn failure, Fontan failure, Senning procedure failure in transposition of the great arteries (TGA), anomalous left coronary artery from the pulmonary artery (ALCAPA) repair failure, and Shone complex. In Group 2, CHD cases included hypoplastic left heart syndrome (HLHS) and tricuspid atresia.\u003c/p\u003e\n\u003cp\u003eAdditional procedures at transplantation included aortic arch enlargement (5 patients in Group 1, 9 in Group 2), superior vena cava reconstruction (5 in Group 1, 7 in Group 2), and pulmonary artery repair (11 in Group 1). Cardiomyopathy was the diagnosis at transplantation in 46 patients in Group 1 and 71 patients in Group 2. Among patients with Norwood failure, redo surgeries involved repeated Norwood procedures, shunt repairs or replacements, and aortic arch re-enlargements. Overall, 53% underwent one prior open-heart surgery, 20% two, 15% three, and 8% more than three. Additionally, 15% had more than three redo surgeries combined with ventricular assist device (VAD) implantation, while 25% had one redo surgery with VAD implantation. Central ECMO via median sternotomy was performed in 7 patients (12%), detailed in Table 2.\u003c/p\u003e\n\u003cp\u003eThe 30-day and 90-day survival are presented in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea and \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eb (Log-rank test: P\u0026thinsp;=\u0026thinsp;0.350 and P\u0026thinsp;=\u0026thinsp;0.169, respectively), showing no significant difference in risk between groups.\u003c/p\u003e\n\u003cp\u003eLong-term survival at 30 years was better in Group 1, although not statistically significant (Log-rank test: P\u0026thinsp;=\u0026thinsp;0.427). Retransplantation-free survival did not differ between groups (Figs. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ec and \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ed).\u003c/p\u003e\n\u003cp\u003eOne child underwent retransplantation 27 days after the initial transplant and died 54 days post-transplant due to graft failure and multiorgan failure. Freedom from re-sternotomy at 90 days was 85% \u0026plusmn; 5% in Group 1 and 78% \u0026plusmn; 5% in Group 2. Early arrhythmias were observed more frequently in Group 2 but resolved by discharge. No significant difference was found in the rate of permanent pacemaker implantation within 90 days post-transplant. Ninety-day post-transplant outcomes are presented in Table 3.\u003c/p\u003e\n\u003cp\u003eUnivariable and multivariable Cox regression analyses for 90-day mortality (Table 4) showed no significant risk factors associated with mortality during this period.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA major challenge in Germany is the shortage of donors, primarily because patients or their guardians must consent to organ donation before brain death is declared. Recent legislation in Germany has classified Donation after circulatory death (DCD) as illegitimate, which contrasts with practices in many European countries, Australia, and the USA where DCD is permitted (\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). urgical reoperation is common in pediatric heart surgery, especially in children with complex congenital heart disease (CHD) (\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e–\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The preparation and timing of pediatric heart transplantation in patients with prior open-heart surgery, particularly those with single ventricle physiology, is crucial to optimize outcomes (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Several authors have shown that transplantation in very young and small patients is significantly associated with mortality (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In our cohort, 30-day and 90-day mortality rates were 4% in patients with prior open-heart surgery and 6% in patients without prior surgery; this difference was not statistically significant. Younger age at transplantation was also not identified as a risk factor for early mortality. At long-term follow-up (Fig.\u0026nbsp;3), survival rates were higher in patients with prior open-heart surgery at transplantation, although this difference was not statistically significant (P = 0.66). Graft survival at long-term follow-up (Fig.\u0026nbsp;4) was similar between groups (P = 0.292). Comparison of these figures showed no indication of graft failure in either early or long-term results.\u003c/p\u003e\u003cp\u003eWhile waiting for a donor organ, more patients required ventricular assist device (VAD) support to stabilize their condition (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Patients with Fontan failure often present with multiorgan dysfunction, protein-losing enteropathy, or plastic bronchitis. Previous reports have demonstrated the efficacy of subpulmonary VAD support as a bridge to transplantation in these patients (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our experience with a novel VAD cannula for subpulmonary support, functional and clinical status improved by the time of transplantation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTwo patients with end-stage CHD due to failed Fontan circulation were supported with VADs, both surviving beyond three years post-transplant. Prior sternotomy has been identified as a risk factor for early graft failure (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Tissot et al. reported that pediatric patients with prolonged donor ischemic time (DIT) had increased necessity for post-transplant ECMO support (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).However, comparing their data to ours was not feasible. In our study, ECMO use in the operating room or ICU was more frequent in patients with prior surgery (Group 1) (p = 0.047), but this was not due to prolonged DIT. Instead, the observed cardiac dysfunction was global and recovered within 24 to 48 hours. Hospital stay duration was not prolonged by post-ECMO support in Group 1. In one patient with Fontan failure, hemodynamic stabilization after superior vena cava and pulmonary artery stenting enabled ECMO weaning, delayed chest closure, and respiratory weaning. Univariable Cox analysis showed no statistically significant effect of pre-transplant VAD support on 90-day mortality (P = 0.585).\u003c/p\u003e\u003cp\u003eSome authors have identified severe arrhythmias as markers of early graft dysfunction or failure; Mylonas et al. reported the necessity of pacemaker implantation early and late post-transplant as a sign of graft failure (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In contrast, Mahmood et al. found pacemaker implantation after pediatric heart transplantation to be rare, with increasing donor age as the only risk factor for graft failure [25]. In contrast, Mahmood et al. found pacemaker implantation after pediatric heart transplantation to be rare, with increasing donor age as the only risk factor for graft failure (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In our experience, patients exhibited initial cardiac arrhythmias in the early post-transplant period, including atrioventricular block and the need for external pacing. However, these conditions resolved within 90 days in the majority of cases.\u003c/p\u003e\u003cp\u003eThis study demonstrated that both early and long-term survival outcomes after pediatric heart transplantation are not significantly affected by a history of prior open-heart surgeries. Despite the increased technical complexity associated with multiple prior interventions, especially in patients with failed Fontan circulation, survival rates at 90 days and during long-term follow-up were comparable to those undergoing primary transplantation. These results suggest that, in experienced centers, repeated sternotomies and prior cardiac surgeries should not be considered absolute contraindications to transplantation. Our findings align with previous studies reporting similar post-transplant outcomes in patients with complex congenital heart disease, underscoring the importance of tailored perioperative planning and surgical expertise.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe heterogeneity of the patient cohort—particularly regarding age, duration of follow-up, indication for heart transplantation, and the number of prior open-heart surgeries—poses challenges for direct comparison of outcomes across groups. These differences underscore the need for future multicenter studies that standardize patient populations, age ranges, and follow-up protocols. Such efforts will enhance the accuracy of comparisons and deepen our understanding of long-term survival and quality of life following pediatric heart transplantation, ultimately enabling more personalized care strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePrior open-heart surgery does not increase the risk of graft failure in either early or long-term follow-up. Although patients without previous heart surgery showed a trend toward better survival, this difference was not statistically significant. Patients with prior open-heart surgery experienced longer aortic cross-clamp times due to adhesions, ventricular assist device (VAD) explantation, or additional cardiac repairs (e.g., aorta, superior vena cava, pulmonary arteries), resulting in extended operative times. Importantly, these factors did not lead to prolonged donor ischemic time (DIT).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eALCAPA: Anomalous left coronary artery from the pulmonary artery. ASD: Atrial septal defect. BMI: Body Mass Index. BVAD: Bi-ventricular assist device. CHD: Congenital heart disease. ECMO/ECLS – Extracorporeal membrane oxygenation / Extracorporeal life support. CI: Confidence interval. CMP: Cardiomyopathy. CPB: Cardiopulmonary bypass. DCD: Donation after circulatory death. DIT: Donor ischemic time. HLHS: Hypoplastic left heart syndrome. HTx: Heart transplantation. ICU: Intensive care unit. IQR: Interquartile range. LVAD: Left ventricular assist device. PHS: Prior open-heart surgery. OR: Odd ratio, RV: Right ventricle. RVAD: Right ventricular assist device. TGA: Transposition of the great arteries. VAD: Ventricular assist device. USA: United State of Amerika.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the [Ethics Committee of Ludwig Maximilians University of Munich] (Approval number:\u0026nbsp;752-15). Informed consent was obtained from all participants or their legal guardians.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations: Not applicable.\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest for any of the authors regarding this report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLLR (L. Lily Rosenthal) contributed to design, performed the literature review, acquisition of data, interpretation, writing and editing the paper. All co-authors contributed to the design and interpretation of data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Dr. Alexander Crispin (Institute for Medical Information Processing, Biometry and Epidemiology; IBE of the Ludwig-Maximilian-University, Munich) for his statistical assistance with this report. We also like to thank Mrs. Anne W\u0026ouml;lffel-Gale for her invaluable editorial assistance in preparing our report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eElahi MM, Kirke R, Lee D, Dhannapuneni RR, Hickey MS. The complications of repeat median sternotomy in paediatrics: six-months follow-up of consecutive cases. Interact Cardiovasc Thorac Surg. 2005;4(4):356\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Brien MF, Harrocks S, Clarke A, Garlick B, Barnett AG. How to do safe sternal reentry and the risk factors of redo cardiac surgery: a 21-year review with zero major cardiac injury. J Card Surg. 2002;17(1):4\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKansara P, Czer L, Awad M, Arabia F, Mirocha J, De Robertis M et al. Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database. Transplantation proceedings. 2014;46(1):249\u0026thinsp;\u0026ndash;\u0026thinsp;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorgan JA, John R, Park Y, Addonizio LJ, Oz MC, Edwards NM, et al. Successful outcome with extended allograft ischemic time in pediatric heart transplantation. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2005;24(1):58\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodrigues W, Carr M, Ridout D, Carter K, Hulme SL, Simmonds J et al. Total donor ischemic time: relationship to early hemodynamics and intensive care morbidity in pediatric cardiac transplant recipients. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2011;12(6):660-6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDas B, Trivedi JR, Sinha P, Ramakrishnan K, Alsoufi B, Deshpande SR. Interplay between donor and recipient factors impacts outcomes after pediatric heart transplantation: An analysis from the united network for organ sharing database. Pediatr Transplant. 2021;25(3):e13912.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTissot C, Buckvold S, Phelps CM, Ivy DD, Campbell DN, Mitchell MB, et al. Outcome of extracorporeal membrane oxygenation for early primary graft failure after pediatric heart transplantation. J Am Coll Cardiol. 2009;54(8):730\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenthal LL, Grinninger C, Ulrich SM, Dalla Pozza R, Haas NA, Brenner P, et al. The impact of pre-transplant ventricular assist device support in pediatric patients with end-stage heart failure on the outcomes of heart transplantation-a single center experience. Front Cardiovasc Med. 2025;12:1515218.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKwon JH, Usry B, Hashmi ZA, Bhandari K, Carnicelli AP, Tedford RJ, et al. Donor utilization in heart transplant with donation after circulatory death in the United States. Am J transplantation: official J Am Soc Transplantation Am Soc Transpl Surg. 2024;24(1):70\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThiessen C, Gordon EJ, Kelly B, Wall A. The ethics of donation after circulatory death organ recovery: an overview of new considerations arising from procurement practice and policy changes. Curr Opin Organ Transplant. 2023;28(2):133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiddiqi HK, Trahanas J, Xu M, Wells Q, Farber-Eger E, Pasrija C, et al. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol. 2023;82(15):1512\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLyle MA, English SW, Goswami RM, Leoni Moreno JC, Nativi-Nicolau J, Yip DS, et al. Donation after circulatory death: A transplant cardiologist's take on neuroprognostication. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2023;42(10):1481\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlomari M, Garg P, Yazji JH, Wadiwala IJ, Alamouti-Fard E, Hussain MWA, et al. Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant? Cureus. 2022;14(6):e26281.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoscik R, Ngai J. Donation After Circulatory Death: Expanding Heart Transplants. J Cardiothorac Vasc Anesth. 2022;36(10):3867\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJawitz OK, Raman V, DeVore AD, Mentz RJ, Patel CB, Rogers J, et al. Increasing the United States heart transplant donor pool with donation after circulatory death. J Thorac Cardiovasc Surg. 2020;159(5):e307\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsoufi BMW, Manlhiot C, Deshpande S, Kogon B, McCrindle BW, Kanter K. Outcomes of heart transplantation in children with hypoplastic left heart syndrome previously palliated with the Norwood procedure. J Thorac Cardiovasc Surg. 2015;Sep 28.:pii: S0022-5223(15)01790-0.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsoufi B, Deshpande S, McCracken C, Kogon B, Vincent R, Mahle W, et al. Outcomes and risk factors for heart transplantation in children with congenital heart disease. J Thorac Cardiovasc Surg. 2015;150(6):1455\u0026ndash;e623.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEveritt MD, Boyle GJ, Schechtman KB, Zheng J, Bullock EA, Kaza AK, et al. Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a multi-institutional study. J heart lung transplantation: official publication Int Soc Heart Transplantation. 2012;31(5):509\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuygrok PN. Transplantation: the final hurdle to longevity in patients with congenital heart disease. Heart. 2019;105(8):582\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDimopoulos K, Muthiah K, Alonso-Gonzalez R, Banner NR, Wort SJ, Swan L, et al. Heart or heart-lung transplantation for patients with congenital heart disease in England. Heart. 2019;105(8):596\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFynn-Thompson F. Heart Transplantation in Adults with Congenital Heart Disease. Methodist Debakey Cardiovasc J. 2019;15(2):145\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRizwan R, Zafar F, Chin C, Tweddell J, Bryant R 3. rd, Morales D. Listing Low-Weight or Ill Infants for Heart Transplantation: Is It Prudent? The Annals of thoracic surgery. 2018;106(4):1189\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMariani C, Loforte A, Gliozzi G, Cavalli GG, Botta L, Mart\u0026igrave;n Suarez S, et al. Impact of prior sternotomy on survival and allograft function after heart transplantation: A single center matched analysis. J Card Surg. 2022;37(4):868\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePr\u0026ecirc;tre R, H\u0026auml;ussler A, Bettex D, Genoni M. Right-sided univentricular cardiac assistance in a failing Fontan circulation. Ann Thorac Surg. 2008;86(3):1018\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichel SG, Menon AK, Haas NA, H\u0026ouml;rer J. Cavopulmonary support with a modified cannulation technique in a failing Fontan patient. Interact Cardiovasc Thorac Surg. 2022;35(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStill S, Shaikh AF, Qin H, Felius J, Jamil AK, Saracino G, et al. Reoperative sternotomy is associated with primary graft dysfunction following heart transplantation. Interact Cardiovasc Thorac Surg. 2018;27(3):343\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh NM, Loomba RS, Kovach JR, Kindel SJ. Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease. Cardiol Young. 2019;29(5):667\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMylonas KS, Repanas T, Athanasiadis DI, Voulgaridou A, Sfyridis PG, Bakoyiannis C, et al. Permanent pacemaker implantation in pediatric heart transplant recipients: A systematic review and evidence quality assessment. Pediatr Transplant. 2020;24(3):e13698.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmood A, Andrews R, Fenton M, Morrison A, Mangat J, Davies B, et al. Permanent pacemaker implantation after pediatric heart transplantation: Risk factors, indications, and outcomes. Clin Transplant. 2019;33(4):e13503.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenthal LL, Grinninger C, Pozza RD, Fischer M, Zimmerling L, Ulrich SM, et al. Impact of the operative technique on mid- and long-term results following paediatric heart transplantation. ESC heart failure; 2024.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Demographic and clinical data of recipients and donors at the time of transplantation.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"106%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ePrior open-heart surgery\u003c/p\u003e\n \u003cp\u003eGroup 1, 60 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eNo open-heart surgery\u003c/p\u003e\n \u003cp\u003eGroup 2, 87 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003cp\u003eN = 147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eRecipient\u0026rsquo;s demographic and clinical baseline data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eAge (y), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e8\u0026plusmn;6 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e9\u0026plusmn;7 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e9\u0026plusmn;7 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eAge groups (years)\u003c/p\u003e\n \u003cp\u003e\u0026lt;2 (n=40)\u003c/p\u003e\n \u003cp\u003e2-6 (n=19)\u003c/p\u003e\n \u003cp\u003e\u0026gt;6-12 (n=26)\u003c/p\u003e\n \u003cp\u003e\u0026gt;12 (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (20%)\u003c/p\u003e\n \u003cp\u003e14 (23%)\u003c/p\u003e\n \u003cp\u003e10 (17%)\u003c/p\u003e\n \u003cp\u003e24 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (32%)\u003c/p\u003e\n \u003cp\u003e6 (7%)\u003c/p\u003e\n \u003cp\u003e16 (18%)\u003c/p\u003e\n \u003cp\u003e37 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (27%)\u003c/p\u003e\n \u003cp\u003e20 (13%)\u003c/p\u003e\n \u003cp\u003e26 (18%)\u003c/p\u003e\n \u003cp\u003e61 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eGender (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e31 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e49 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e80 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eWeight (kg) mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e28.9\u0026nbsp;\u0026plusmn; 22 (77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e29\u0026nbsp;\u0026plusmn; 23 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e29 \u0026plusmn; 22 (77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16\u0026nbsp;\u0026plusmn; 4 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e16\u0026nbsp;\u0026plusmn; 3 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e16 \u0026plusmn; 4 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eWaiting time on list for transplantation (days)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e189\u0026nbsp;\u0026plusmn; 146 (852)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e129\u0026nbsp;\u0026plusmn; 70 (852)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e158 \u0026plusmn; 100 (971)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eECMO/ECLS implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e7 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eCHD\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHLHS/hypoplastic RV\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNorwood failure\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGlenn failure\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFontan failure\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSenning failure by TGA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eALCAPA repair failure\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCongenital valve stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16 (23%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003cp\u003e4 (6%)\u003c/p\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e28 (19%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (9%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003cp\u003e4 (3%)\u003c/p\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eCMP\u003c/p\u003e\n \u003cp\u003eDCM\u003c/p\u003e\n \u003cp\u003eRestrictive CMP\u003c/p\u003e\n \u003cp\u003eHypertrophic CMP\u003c/p\u003e\n \u003cp\u003eNon-compaction CMP\u003c/p\u003e\n \u003cp\u003eIschemic CMP\u003c/p\u003e\n \u003cp\u003eToxic CMP\u003c/p\u003e\n \u003cp\u003eMyocarditis\u003c/p\u003e\n \u003cp\u003eCarvajal syndrome\u003c/p\u003e\n \u003cp\u003eKawasaki syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003cp\u003e26 (43%)\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003cp\u003e7 (12%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003cp\u003e61 (70%)\u003c/p\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e119 (81%)\u003c/p\u003e\n \u003cp\u003e87 (59%)\u003c/p\u003e\n \u003cp\u003e4 (3%)\u003c/p\u003e\n \u003cp\u003e5 (4%)\u003c/p\u003e\n \u003cp\u003e8 (6%)\u003c/p\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003cp\u003e8 (6%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eDonor\u0026rsquo;s demographic and clinical baseline data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eGender (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e33 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e46 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e79 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eAge (y), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e15 \u0026plusmn; 14 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e15 \u0026plusmn; 14 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e14 \u0026plusmn; 13 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eWeight (kg), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e38 \u0026plusmn; 26 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e35 \u0026plusmn; 25 (93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e36 \u0026plusmn; 26 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eDonor- BMI (kg/m\u003csup\u003e2\u003c/sup\u003e), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e18 \u0026plusmn; 6 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e18 \u0026plusmn; 4 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e18 \u0026plusmn; 5 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePerioperative Data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eOrgan preservation solution\u003c/p\u003e\n \u003cp\u003eHTK\u003c/p\u003e\n \u003cp\u003eUW2\u003c/p\u003e\n \u003cp\u003eCelsior\u003csup\u003e\u0026reg;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (61%)\u003c/p\u003e\n \u003cp\u003e23 (38%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (30%)\u003c/p\u003e\n \u003cp\u003e56 ((64%)\u003c/p\u003e\n \u003cp\u003e4 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64 (42%)\u003c/p\u003e\n \u003cp\u003e79 (55%)\u003c/p\u003e\n \u003cp\u003e4 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eIschemic time - donor (minutes), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e235 \u0026plusmn; 60 (285)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e234 \u0026plusmn; 48 (229)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e254 \u0026plusmn; 53 (285)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eSkin-to-skin (minutes), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e372 \u0026plusmn; 107 (588)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e253 \u0026plusmn; 48 (232)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e301 \u0026plusmn; 97 (588)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eCPB time (minutes), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e191 \u0026plusmn;65 (209)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e189 \u0026plusmn; 65 (232)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e190 \u0026plusmn; 55 (232)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eAortic cross clamp-time (minutes), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e88 \u0026plusmn; 29 (157)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e75 \u0026plusmn; 25 (168)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e81 \u0026plusmn; 28 (178)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003ePost transplant ECMO/ ECLS implantation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e25 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eDelayed chest closure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e14 ((23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e11 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e24 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eLength of ventilation support (hours)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 10\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11-24\u003c/p\u003e\n \u003cp\u003e25-50\u003c/p\u003e\n \u003cp\u003e\u0026gt; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (28%)\u003c/p\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003cp\u003e24 (40%)\u003c/p\u003e\n \u003cp\u003e9 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (45%)\u003c/p\u003e\n \u003cp\u003e18 (21%)\u003c/p\u003e\n \u003cp\u003e21 (24%)\u003c/p\u003e\n \u003cp\u003e9 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e33 \u0026plusmn; 28\u003c/p\u003e\n \u003cp\u003e56 (38%)\u003c/p\u003e\n \u003cp\u003e29 (20%)\u003c/p\u003e\n \u003cp\u003e45 (31%)\u003c/p\u003e\n \u003cp\u003e16 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eICU-Stay (days), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e29 \u0026plusmn; 27 (164)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e87 \u0026plusmn; 34 (737)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e69 \u0026plusmn; 31 (738)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eHospital-length (days), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e191 \u0026plusmn; 185 (916)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e127 \u0026plusmn; 93 (474)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e151 \u0026plusmn; 142 (942)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eHospital-stay after HTx (days), mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e50 \u0026plusmn; 45 (916)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e101 \u0026plusmn; 66 (768)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e56 \u0026plusmn; 83 (810)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eContinuous variables are presented as mean \u0026plusmn; standard deviation (range) and were analyzed using a \u003cem\u003et\u003c/em\u003e-test. Categorical variables (n, %) were analyzed using crosstabulations (chi-square test). A two-sided \u003cem\u003ep\u003c/em\u003e-value \u0026le; 0.05 was considered statistically significant. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eNumber of prior open-heart surgeries and types of procedures performed.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"349\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003ePrevious open-heart surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eNumber of previous surgeries*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eOnly 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026gt; 3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eFailed procedures + ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eFailed procedures + VAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eECMO to VAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eVAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e34 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eType of failed procedures*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eNorwood\u003cstrong\u003e, shunt repair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNorwood, Shunt repair, Gle\u003c/strong\u003enn\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNorwood, Shunt repair, Gle\u003c/strong\u003enn\u003cstrong\u003e, Fontan, Valve replacement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003ePA Banding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eASD enlargement / ASD Closure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eALCAPA repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eFailed Senning\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eAortic valve and mitral valve repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eFailed Ross procedure and CBAG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eCentral ECMO/ ECLS Support\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e7 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eVAD implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e44 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eLVAD\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e37 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eBVAD\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eRVAD\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*More than one type of previous heart surgery is possible. Categorical variables were analyzed using crosstabulations (Chi-square test). Abbreviations: ASD, atrial septal defect; ALCAPA, anomalous left coronary artery from the pulmonary artery; \u0026sup1;only ventricular assist device support; \u0026sup2;only central ECMO/ECLS (veno-arterial), extracorporeal membrane oxygenation/extracorporeal life support; \u0026sup3;LVAD, left ventricular assist device; ⁴BVAD, bi-ventricular assist device; ⁵RVAD, right ventricular assist device.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3: Clinical outcomes at 90 days following pediatric heart transplantation.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eRedo open-heart surgery\u003c/p\u003e\n \u003cp\u003eGroup 1, 60 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eFirst open-heart surgery\u003c/p\u003e\n \u003cp\u003eGroup 2, 87 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003cp\u003eN = 147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eECMO/ECLS implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e16 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e12 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e28 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eDelated chest closure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e14 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e24 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eRenal dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e19 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e40 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e59 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eDialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e13 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e26 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e39 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eCardiac arrythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e26 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e50 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e76 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003ePacemaker implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eWound dehiscent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e10 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e13 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e23 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eWound revision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e7 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e16 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e15 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e23 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e31 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e54 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eEffusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e17 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e32 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e49 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eResternotomy\u0026nbsp;(bleeding\u0026nbsp;or pericardial effusion)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e10 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e18 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e16 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eDiaphragm paresis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e6 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e10 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eEarly graft failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e16 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e26 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eLate graft failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e19 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e36 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e54 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCategorical variables, expressed as counts and percentages (n; %), were analyzed using crosstabulations (chi-square test). A p-value \u0026le; 0.05 was considered statistically significant. Abbreviations: ECMO/ECLS \u0026ndash;Extracorporeal Membrane Oxygenation / Extracorporeal Life Support; HTx \u0026ndash; Heart Transplantation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Univariable Cox proportional hazards analysis of risk factors associated with 90-day mortality.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003eUnivariable Cox analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eRecipient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAge (per years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.016 (0.922-1.120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.535 (0.138-2.071)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBody weight (per kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.008 (0.981-1.035)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBMI (per kg/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.013 (0.857-1.198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eIndication for HTX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e2.926 (0.722-11.867)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003ePre- HTx ECLS / ECMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.000 (0.000-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003ePre- HTx VAD Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.462 (0.029-7.380)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eWaiting on the list (per days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.999 (0.993-1.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eDonor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAge (per years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.008 (0.968-1.050)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.275 (0.058-1.296)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBody weight (per kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.013 (0.988-1.038)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBMI (kg/cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.109 (0.973-1.263)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eEarly / primary graft failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.285 (0.060-1.359)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eECLS/ECMO support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e2.503 (0.640-9.790)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.196 (0.337-4.238)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eEffusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.197 (0.025-1.563)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eRedo sternotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.059 (0.224-5.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eRenal dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.000 (0.281-3.553)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eDialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.632 (0.145-3.229)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eCardiac arrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.331 (0.085-1.292)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003ePacemaker implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.331 (0.280-6.334)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eNeurological (infarction /bleeding)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.343 (0.073-1.616)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eOrgan preservation solution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e6.068 (0.750-49.121)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eIschemic time per minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.000 (0.988-1.013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAortic clamp time per minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.017 (1.000-1.034)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eCPB time (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e1.007 (0.993-1.016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eSkin-to-skin (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e0.997 (0.986-1.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e BMI: Body Mass Index; HTx: Heart Transplantation; ECMO/ECLS: Extracorporeal Membrane Oxygenation / Extracorporeal Life Support; VAD: Ventricular Assist Device; CPB: Cardiopulmonary Bypass\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Congenital Heart Disease, Failed Heart Surgery, Pediatric Cardiac Surgery, Pediatric Heart Failure, Prior Open-Heart Surgery","lastPublishedDoi":"10.21203/rs.3.rs-7325799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7325799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003cbr\u003e\n \u003c/strong\u003eThis study aimed to evaluate the impact of prior open-heart surgery (PHS) on early mortality and morbidity following pediatric heart transplantation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003cbr\u003e\n \u003c/strong\u003eWe 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n \u003c/strong\u003eMean 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003cbr\u003e\n \u003c/strong\u003ePrior 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.\u003c/p\u003e","manuscriptTitle":"The Persistent Influence of Prior Open-Heart Surgery on Early Outcomes After Pediatric Heart Transplantation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 18:47:49","doi":"10.21203/rs.3.rs-7325799/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"76eec32b-6078-4a58-a190-d69db73fe220","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T08:26:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 18:47:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7325799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7325799","identity":"rs-7325799","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}