Cardiovascular interventions after orthotopic heart transplantation

Introduction: Little is currently known about the prevalence and clinical outcome of cardiovascular interventions after orthotopic heart transplantation.

Methods: We checked our patient records for heart transplant recipients with renewed cardiovascular surgery and evaluated their clinical outcome.

Results: Between January 1989 and August 2011, 21 out of 1,797 patients (1.2%) underwent a total of 25 renewed cardiovascular surgeries. Mean age was 60 years (range, 21–73 years). Mean interval between transplantation and the first reoperation was 79 months (range: 1–216 months). Sixteen (80%) patients were male, and 4 (20%) female tender. Seven patients underwent a total of 10 ascending aorta or arch replacements, 5 patients had a tricuspid valve replacements, 4 patients underwent a total of 5 mitral valve replacements, 1 patient needed an aortic valve replacement, 1 patient had combined aortic valve replacement and coronary artery bypass grafting, 1 patient underwent Off-pump coronary artery bypass grafting and 2 patients underwent right atrial thrombectomies. In 8 cases, prolonged hospitalizing (≥14 days) was necessary due to pneumonia (n=3), pneumonia plus anuria (n=1), chylothorax (n=1), stroke (n=1), heart failure (n=1) and multiple organ failure (n=1). Two early deaths (≤30 days) and 7 late deaths (>30 days) occurred. The 2 early deaths were caused by intra-operative bleeding and multiple organ failure. Causes of late deaths were chronic graft failure (n=2), bleeding (n=3), sepsis (n=1) and unknown cause (n=1). Actuarial survival rates after renewed cardiac surgery at 1, 5, and 10 years were 75.4%, 69.6%, and 46.4%, respectively.

Conclusion: In heart transplant recipients, cardiac reoperation leads to acceptable long term results.