A retrospective registry cohort compared severe primary graft dysfunction after heart transplantation in 3,406 recipients with durable LVADs, other prior cardiac surgery, or no prior surgery. Severe graft dysfunction occurred in 11.1% versus 10.9% of LVAD and other prior-surgery recipients (adjusted OR 0.81, 95% CI 0.50–1.32), versus 4.2% without prior surgery (LVAD adjusted OR 2.17, 95% CI 1.50–3.13). Mortality at 180 days was 8.5% in both prior-surgery groups (adjusted HR 0.98, 95% CI 0.58–1.65), versus 4.2% without prior surgery (LVAD adjusted HR 2.13, 95% CI 1.46–3.13).
Prior surgical history may help contextualize graft dysfunction risk after transplantation. These findings do not establish equivalence between LVAD and other prior-surgery recipients or prove that surgical reentry causes the excess risk.
Study limitation: Retrospective registry comparisons remain vulnerable to residual confounding; the contribution of surgical reentry cannot be isolated causally.
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