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Late cardiac reoperation after cardiac transplantation
V Seenu Reddy1, Ho H Phan, Richard N Pierson
1Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Subsequent cardiac procedures after heart transplantation, including retransplantation, are safe and effective for carefully selected patients. These interventions improve long-term survival and graft function, offering gratifying intermediate-term results.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Cardiac transplantation outcomes are improving.
- Post-transplant cardiac procedures may be necessary for long-term survival and graft health.
Purpose of the Study:
- To evaluate the safety and efficacy of subsequent cardiac procedures in heart transplant recipients.
Main Methods:
- Retrospective review of medical records for adult and pediatric cardiac transplant recipients undergoing a second cardiac procedure.
- Analysis of procedure types, intervals, and patient outcomes.
Main Results:
- Seventeen of 360 heart transplant recipients underwent a subsequent procedure (e.g., retransplantation, CABG, aortic repair, valve repair).
- The mean interval to the second procedure was 8.3 years.
- One perioperative death occurred; two late deaths were associated with retransplantation. Survivors showed good outcomes with a mean follow-up of 26.6 months.
Conclusions:
- Subsequent cardiac procedures, beyond retransplantation, can be safely performed in selected heart transplant patients.
- These procedures demonstrate gratifying intermediate-term survival and symptom-free status.
Background:
The intermediate and long-term results of cardiac transplantation continue to improve. Subsequent cardiac procedures may be required to extend patient survival and protect graft function.
Methods:
The medical records of all adult and pediatric cardiac transplant recipients who underwent a subsequent cardiac procedure at our institution were reviewed.
Results:
Three hundred sixty patients have undergone primary orthotopic transplantation in our institution. Seventeen patients (12 adults, 5 children) underwent a subsequent procedure requiring cardiopulmonary bypass including cardiac retransplantation (10), coronary artery bypass grafting (3), ascending aortic replacement (2), tricuspid valve repair (1), and myotomy and myomectomy (1 patient). Mean interval from time of transplantation to second procedure was 8.3 years. There was one perioperative death. Two patients, both retransplants, died late postoperatively at 22 and 84 months, respectively. Overall mean follow-up in the late survivors is 26.6 months. All survivors are currently asymptomatic and doing well.
Conclusions:
A variety of subsequent cardiac procedures, in addition to retransplantation, can be performed safely in carefully selected cardiac transplant recipients. The intermediate term results are gratifying in terms of survival and freedom from symptoms.