The effects of improved hemodynamics on aortic dimensions in patients undergoing heart transplantation

Bull, David A.; Neumayer, Leigh; Venerus, Bryan J.; Putnam, Charles W.; Rosado, Luis J.; Lund, Pamela J.; McIntyre, Kenneth E.; Bernhard, Victor M.; Copeland, Jack G.; Sethi, Gulshan K.; Hunter, Glenn C.

doi:10.1016/0741-5214(94)90278-x

Cited by 17 publications

(11 citation statements)

References 8 publications

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“…11-16 Following heart transplantation reported growth rates have ranged from 0.74 to 2.1 cm/year. 1,2,4,6,9,24 This published experience is similar to that of the present study where the mean aneurysm growth rate was 1.2 cm/year following OHT. Several studies have attributed the faster aneurysm growth rate in OHT patients to the use of corticosteroid immunosuppressive regimens.…”

Section: Discussionsupporting

confidence: 92%

Abdominal Aortic Aneurysms Following Orthotopic Heart Transplantation

Fazel¹,

Lawlor

Forbes

2004

Vasc Endovascular Surg

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The purpose of these authors' study was to analyze their center's experience with orthotopic heart transplantation (OHT) and abdominal aortic aneurysms (AAA) with particular attention to corticosteroid dosing, hemodynamic parameters, and aneurysm growth rate. A retrospective review of all patients (453) who underwent OHT at their university-affiliated medical center over an 18-year period (1981-1999) was undertaken. Nine (2%) patients who developed AAAs were identified and aneurysm growth was correlated with corticosteroid immunosuppression and hemodynamic parameters. The mean age of OHT patients was 44.5 +/-15 years and the majority were males (371 males, 82%). Median follow-up was 5.7 years. Ischemic cardiomyopathy (IC) was the most common indication for transplantation (45.5% of patients). All AAA patients were male (p=0.157), with a mean age of 58.4 +/-4.8 years (p=0.001), and had undergone OHT for IC (p=0.001). Mean arterial blood pressure and ejection fraction in the AAA patients had increased from pretransplant values of 107 mm Hg and 14.3 +/-5.7% to 142 mm Hg (p=0.017) and 54.1 +/-14.1% (p<0.001), respectively, before aneurysm repair. Mean aneurysm diameter at the time of repair was 6.0 +/-0.8 cm, and the average growth rate was 1.2 +/-0.4 cm/year in the 4 patients in whom it could be measured. Aneurysm repair was performed urgently in 2 patients and electively in 7 patients with 1 early postoperative death (11%). The extent of corticosteroid immunosuppression, corticosteroid pulses, and total corticosteroid dosing did not correlate with the rate of aneurysm growth. Improved hemodynamics and progressive posttransplant hypertension may contribute to aneurysm formation and growth in this group of patients.

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Section: Discussionsupporting

confidence: 92%

Abdominal Aortic Aneurysms Following Orthotopic Heart Transplantation

Fazel¹,

Lawlor

Forbes

2004

Vasc Endovascular Surg

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“…Indeed, the presence of a strong new donor heart along with the collagen weakening effect of immunosuppression may have detrimental effects on the inherently weakened aorta. This concern is also supported by the observation of an increased incidence and a more aggressive course of abdominal aortic aneurysms in transplant recipients (both heart and abdominal organ transplantations) 14 15. There are no evidence-based guidelines for adequate preventive treatment of the weakened aorta in this specific case but it has been demonstrated that the need for reintervention in the distal aorta of patients with MFS with previous aortic root surgery is significantly increased in patients with previous hypertension as compared to those without hypertension 16.…”

Section: Discussionmentioning

confidence: 91%

Type B aortic dissection triggered by heart transplantation in a patient with Marfan syndrome

et al. 2015

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Heart transplantation in patients with Marfan syndrome is challenging and raises concerns with regards to the haemodynamic and immunosuppressive-induced effects on the inherently fragile aorta. Most aortic events following transplantation reported so far in the literature occurred in patients with pre-existent distal aortic dissection. We report a case of successful orthotopic heart transplantation in a patient with Marfan syndrome that was complicated by late-onset type B dissection in pre-existing mild and stable distal aortic dilation. Serial aortic imaging revealed progressive growth at the level of the descending thoracic aorta. An open thoracoabdominal aortic repair procedure was successfully performed 6 months after the transplantation.

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“…The high incidence of arterial hypertension, diabetes mellitus, and accelerated arteriosclerosis caused by immunosuppression predisposes heart transplantation patients to this complication. Of note, accelerated growth of true atherosclerotic aneurysms of the ascending aorta, 10 increased growth of abdominal aortic aneurysms, 11 and increased incidence of perivascular disease 12 have all been reported in heart transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Acute type A aortic dissection in a cardiac allograft recipient: case report and review of the literature

Schellemans

2004

Heart

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The effects of improved hemodynamics on aortic dimensions in patients undergoing heart transplantation

Abstract: Of 68 heart transplant patients prospectively evaluated, aortic diameter increased in 31 (46%); new aneurysms developed in four of these patients. Greater incremental increases in cardiac ejection fraction were significant correlates with aortic enlargement.

Cited by 17 publications

References 8 publications

Abdominal Aortic Aneurysms Following Orthotopic Heart Transplantation

Abdominal Aortic Aneurysms Following Orthotopic Heart Transplantation

Type B aortic dissection triggered by heart transplantation in a patient with Marfan syndrome

Acute type A aortic dissection in a cardiac allograft recipient: case report and review of the literature

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