[Late cerebrovascular complications of cardiac transplantation]

Area of Science:

• Cardiology
• Neurology
• Transplantation Medicine

Background:

• Stroke is an uncommon post-operative complication following cardiac transplantation.
• Patients undergoing cardiac transplantation often have pre-existing vascular risk factors, complicating stroke risk assessment.

Purpose of the Study:

• To evaluate the frequency and mechanisms of cerebrovascular complications in the early post-operative period after orthotopic cardiac transplantation.
• To identify potential contributing factors to stroke occurrence in this patient population.

Main Methods:

• Retrospective review of clinical records of 303 consecutive patients who underwent orthotopic cardiac transplantation between March 1985 and December 1996.
• Selection criteria included patients who developed a stroke within the first 2 months postoperatively.

Main Results:

• Six patients experienced cerebrovascular events: four with cerebral infarct and two with intracranial hemorrhage.
• The overall risk of late cerebrovascular complications was estimated at 2.6% at 5 years.
• Ischemic stroke etiologies included cardiac embolus, lacunar infarction, and undetermined causes.

Conclusions:

• While rare, stroke is a significant concern after cardiac transplantation.
• Potential contributing factors include pre-transplantation vascular risk factors, intracardiac thrombus, immunosuppressive therapy, surgical procedure, and cardiac rejection.