Cerebrovascular complications after heart transplantation

Area of Science:

• Cardiology
• Neurology
• Transplantation Medicine

Background:

• Neurological complications, particularly cerebrovascular events, are a major cause of morbidity and mortality following orthotopic heart transplantation.
• While delirium and encephalopathy are frequent, stroke represents a significant concern with a 5-year risk of 4.1% post-transplant.

Purpose of the Study:

• To analyze the incidence, timing, risk factors, and outcomes of cerebrovascular complications in patients undergoing heart transplantation.
• To identify key predictors for perioperative and late-phase stroke to guide clinical management and improve patient prognosis.

Main Methods:

• Retrospective study involving 314 patients who underwent cardiac transplantation.
• Analysis of neurological complication data, focusing on the timing, type, and associated risk factors of cerebrovascular events.

Main Results:

• Cerebrovascular complications occurred in 5-11% perioperatively and 20% within two weeks post-transplant, with 80% in the late phase.
• Ischemic stroke is the most common subtype. Perioperative risk factors include hemodynamic instability, prolonged extracorporeal circulation, and prior stroke history.
• Late-phase stroke is primarily associated with prior stroke history, while undetermined cause is the most prevalent etiologic subtype per TOAST classification.

Conclusions:

• Cerebrovascular complications significantly impact mortality and functional outcomes after heart transplantation.
• Identifying and mitigating perioperative risk factors is crucial, as is monitoring patients with a history of stroke for late-phase events.
• Further research into the etiology of undetermined strokes post-transplant is warranted.