Cerebrovascular Disease as a Complication of Cardiac Transplantation

Abstract

Background and Objectives: To characterize the frequency, risk factors, clinical presentation and etiological subtypes of cerebrovascular diseases (CVD) following cardiac transplantation (CTX). Methods: In a retrospective review of our CTX database (period 1984–2002), we assessed demographic data, vascular risk factors, surgery and donor details. We classified ischemic stroke (IS) using the clinical criteria of the Oxfordshire Community Stroke Project and the etiological criteria of the TOAST study. Logistic regression analysis and survival curves were carried out. Results: CTX was performed in a total of 314 patients (age 46 ± 14 years, 78% male) and mean follow-up was 54 ± 57 months. Twenty-two patients (7%) presented CVD: hemorrhagic stroke in 12%, transient ischemic attack in 28% and IS in 60%. CVD were early postoperative (less than 2 weeks) in 20% of patients and late in 80%. The clinical presentation in patients with IS was total anterior circulation (23.1%), partial anterior (38.4%), lacunar (15.4%) and posterior circulation (23.1%), and the etiological classification was large artery atherosclerosis (15.4%), cardioembolism (14.4%), small vessel disease (15.4%), unusual causes (15.4%) and undetermined cause (38.4%). The only independent predictor of CVD was a prior CVD event with an odds ratio of 8.2 (95% CI, 2.2–30.2, p < 0.02). The estimated risk of CVD at 5 years was greater (p < 0.02) in patients with prior CVD (4.1%) than in those without (1.1%). Conclusions: CVD are a relatively frequent complication after CTX (7%) and usually occur in the late postoperative phase. CVD prior to transplantation increase the risk of CVD after this procedure.

Outcomes in adult congenital heart disease patients undergoing heart transplantation: A systematic review and meta-analysis

“…These factors may contribute to the higher incidence of stroke in adult CHD patients undergoing heart transplantation. [34][35][36] The risk for reoperation post-transplantation in CHD patients was similar to non-CHD patients. Given the increased mortality secondary to hemorrhage, this was surprising.…”

Interobserver Agreement in the Trial of Org 10172 in Acute Stroke Treatment Classification of Stroke Based on Retrospective Medical Record Review

“…The TOAST system has been applied retrospectively in several studies of highly diverse patient populations, including cardiac transplant patients (26), pediatric patients (27), and cancer patients (28). Clinical practice variability in evaluating ischemic stroke leads inevitably to variability in the clinical data available for classifying stroke retrospectively in the research setting (29).…”

Relationship Between Cerebral Blood Flow and Blood Pressure in Long-Term Heart Transplant Recipients

“…For example, neurological impediments develop in ≈60% to 80% of heart transplant recipients [3][4][5] and have a 14% to 18% greater occurrence rate of cerebral hemorrhage or ischemic stroke. 3,[5][6][7] The exact mechanism for these derangements, however, remains to be elucidated; however, adverse events may be the direct consequence of life-long immunosuppressant therapy 8 or vascular remodeling secondary to chronic cerebral hypoperfusion associated with pretransplant heart failure. 4,5,7 We asked whether alterations in cerebral pressure-flow dynamics could also explain the increased risk.…”