Cardiac surgery in the heart transplant recipient: Outcome analysis and long‐term results

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Survival rates following cardiac transplantation continue to improve.Due to the scarcity of available organs, extended donor criteria have become more prevalent in clinical practice. In this context, the risk of developing cardiac pathology requiring surgical correction is increasing. Methods: Between January 1991 and October 2010, a total of 479 patients received cardiac transplantations at the University Hospital Heidelberg. Of those, 18 (3.8%) patients required subsequent cardiac surgery until 2018. Short-and long-term analyses were performed. Results: Indications for cardiac surgery included valvular disease (n = 16) with the majority of cases affecting the tricuspid valve (n = 10), while 6 patients received mitral valve surgery, of whom 3 patients underwent concomitant valve surgery. Otherindications included CABG (n = 1) and re-transplantation (n = 1) for allograft dysfunction. Mean follow-up time was 6.5 years, while mean interval to surgery was 6.0 years. Early mortality was 11.1% (n = 2), while overall survival at 1, 5, and 10 years were, 88.1%, 81.4%, and 52.2%, respectively. Compared to an overall survival of that transplant cohort at 1, 5, and 10 years of 76.7%, 66.7%, and 52.4% percent, respectively (P = .271).Conclusion: According to our data, redo cardiac surgery can be performed with acceptable mortality and morbidity. Atrioventricular valve pathology plays a chief role in these patients. K E Y W O R D Sheart transplant, outcome analysis, repeat surgery

A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention

“…The postoperative evolution was marked by high rates of prolonged ventilation (33%), new-onset requirement of hemodialysis treatment (36.8%), and infectious complications (11.1%). The reported early mortality was 11.1% [11].…”

“…Although prompt surgical repair of severe TR that develops early after transplantation is regarded as a safe procedure in selected patients, with an improvement in the overall survival after 1, 5 and 10 years due to better cardiac performance and alleviation of associated organ dysfunction, this redo surgery is not risk-free [11,38]. The postoperative evolution was marked by high rates of prolonged ventilation (33%), new-onset requirement of hemodialysis treatment (36.8%), and infectious complications (11.1%).…”

“…A p-value of less than 0.05 was considered significant. Conversion to mean and standard deviation (SD), when median and IQR were available, was performed following the methods published by Luo et al and Wan et al [10,11]. The pooled sample mean and pooled standard deviation for selected studies were calculated according to the Cochrane Handbook's recommendation for Systematic Reviews.…”

“…The most frequently reported indication for heart surgery after HTX was the atrioventricular valve reconstructions or replacement. 62.5% of these cases were related to the tricuspid valve [11]. Surgical repair or replacement is required when right heart failure becomes refractory to conservative medical treatment [10,12].…”

Neuregulin-1, in a Conducive Milieu with Wnt/BMP/Retinoic Acid, Prolongs the Epicardial-Mediated Cardiac Regeneration Capacity of Neonatal Heart Explants

“…Ablation of either the sympathetic [12] or parasympathetic [11] cardiac nerves abrogates the innate regenerative potential of the neonatal heart, suggesting that non-redundant contributions from both branches of autonomic nerves are required to support full cardiac regeneration. Neuronal input may also be required for cardiac homeostasis, as heart failure following cardiac transplantation, where the transplanted heart is denervated, remains a common outcome [13] .…”