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Updated: Jun 14, 2026
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Cardiac surgery late after heart transplantation: a safe and effective treatment option
Heidi Goerler1, Andre Simon, Gregor Warnecke
1Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. goerler.adelheid@mh-hannover.de
Insights
Non-retransplant cardiac surgery offers a safe and effective treatment for late-onset cardiac allograft vasculopathy and valvular disease after heart transplantation, demonstrating low early mortality and favorable long-term survival rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Immunology
Background:
- Late complications after heart transplantation, including cardiac allograft vasculopathy and valvular disease, are increasingly prevalent.
- Improved long-term survival post-transplant necessitates effective management strategies for these developing conditions.
Purpose of the Study:
- To evaluate the outcomes of non-retransplant cardiac surgery in patients with late complications after heart transplantation.
- To compare the results of non-retransplant surgery with those of cardiac retransplantation.
Main Methods:
- Retrospective analysis of 44 patients undergoing non-retransplant cardiac surgery (including coronary artery revascularization, valve procedures, aortic operations) after initial heart transplantation.
- Comparison of outcomes with 20 patients who underwent late cardiac retransplantation.
- Long-term follow-up and survival analysis.
Main Results:
- Non-retransplant surgery was performed for cardiac allograft vasculopathy, tricuspid regurgitation, and other valvular/aortic issues, with a mean follow-up of 5.8 years.
- Early mortality for non-retransplant surgery was 4.5%, significantly lower than the 20% in the retransplant group.
- Actuarial survival rates at 1, 5, and 7 years were 84%, 64%, and 58% for non-retransplant surgery, compared to 70%, 70%, and 47% for retransplantation.
Conclusions:
- Non-retransplant surgical interventions are a safe and effective therapeutic option for managing cardiac allograft vasculopathy and valvular disease post-heart transplant.
- These procedures offer acceptable long-term results with considerably lower early mortality compared to retransplantation.
Objective:
Owing to the improved long-term outcome after cardiac transplantation, cardiac allograft vasculopathy or valvular disease is developing late after heart transplantation in a growing number of patients. In this study, we evaluated our results of nonretransplant cardiac surgery in these patients and compared them with those after retransplantation.
Methods:
Since 1983, a total of 867 heart transplantations have been performed at our institution. Among them, 44 patients underwent nonretransplant cardiac surgery, 4 of them repeatedly. The procedures included 19 coronary artery revascularizations, 20 tricuspid valve procedures, 4 other valvular procedures, 4 aortic operations, and 1 right atrial thrombectomy. Long-term results of these patients were compared with those of 20 patients after late cardiac retransplantation.
Results:
Indications for nonretransplant surgery included cardiac allograft vasculopathy, tricuspid regurgitation, aortic and mitral valve insufficiency, as well as acute aortic dissection type A. Mean interval between heart transplantation and reoperation was 8.4 years. Mean follow-up was 5.8 years. Early mortality was 4.5% (2/44). The early deaths were caused by intracerebral bleeding and acute rejection. Actuarial survivals at 1, 5, and 7 years were 84%, 64%, and 58%, respectively. In comparison, early mortality in the retransplant group was 20% (4/20) and survivals at the same time points were 70%, 70%, and 47%, respectively.
Conclusions:
According to these results, we consider nonretransplant surgical options for cardiac allograft vasculopathy and valvular disease a safe and effective therapeutic approach with low early mortality and acceptable long-term results.
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