VAD-Associated Redo Sternotomy and Post-Transplant Survival in Pediatric Heart Transplantation

Authors

• Asmita Sharma, Pediatric Cardiology Fellow - Corewell Health West
• Raisa Razalan-Clarey, Pediatric Cardiology Fellow - Corewell Health West
• Rohit Ganduboina
• Osama Eltayeb, Pediatric Cardiothoracic Surgery - Corewell Health West
• Marcus Haw, Pediatric Cardiothoracic Surgery - Corewell Health West
• Jean Ballweg, Pediatric Cardiac Transplant - Corewell Health West
• Sandeep Sainathan, Pediatric Cardiothoracic Surgery - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Redo sternotomy in pediatric heart transplantation is a high-risk operative context, and redo sternotomy performed in the setting of ventricular assist device (VAD) support may represent a distinct, VAD-associated surgical phenotype.

United Network for Organ Sharing (UNOS) registry (2002-2025), was used to identify pediatric heart transplant recipients with redo sternotomy. Patients were stratified by VAD support at transplant (VAD-associated redo sternotomy) and without VAD support (non-VAD-associated redo sternotomy). Recipient, donor, waitlist, and transplant characteristics were compared using standardized statistical tests. To quantify absolute survival differences, restricted mean survival time (RMST) was estimated at 1-, 5-, and 10-years.

Among 11,983 pediatric heart transplant recipients, 3,253 (27.1%) underwent redo sternotomy and comprised the study cohort. Of these, 1,468 (45.1%) had VAD-associated redo sternotomy, while 1,785 (54.9%) underwent redo sternotomy without VAD support. Patients with VAD-associated redo sternotomy were older, had higher body mass index, and more commonly had cardiomyopathy, whereas congenital heart disease predominated in the non-VAD-associated group. VAD-associated redo sternotomy was associated with higher rates of blood transfusion and mechanical ventilation, but lower intravenous inotrope use and shorter hospital length of stay (all p< 0.001) (Table 1). Early post-transplant survival was higher in the VAD-associated redo sternotomy group at 30 days, 90 days, 1 year (all p< 0.001) and 5year survival (p-0.002). Despite higher pre-transplant acuity, Kaplan-Meier analysis demonstrated improved unadjusted post-transplant survival among patients with VAD-associated redo sternotomy.

Redo sternotomy in the setting of VAD support is associated with improved early post-transplant survival and modest absolute survival gains over time.

Recommended Citation

Sharma A, Razalan-Cleary R, Ganduboina R, Eltayeb O, Haw M, Ballweg J, Sainathan S. VAD-associated redo sternotomy and post-transplant survival in pediatric heart transplantation. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2133