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Updated: May 29, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Outcomes in patients with symptomatic cerebrovascular disease undergoing heart transplantation
Vishnu Patlolla1, Vanajakshi Mogulla, David DeNofrio
1Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Insights
Patients with symptomatic cerebrovascular disease (sCVD) face higher risks of stroke and functional decline after heart transplantation, though not increased mortality. These findings aid in evaluating sCVD patients for heart transplants.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Symptomatic cerebrovascular disease (sCVD) is a relative contraindication for heart transplantation.
- Outcomes for heart transplant recipients with sCVD are not well-defined.
Purpose of the Study:
- Determine outcomes in heart transplant patients with and without symptomatic cerebrovascular disease (sCVD).
- Identify factors associated with perioperative stroke after heart transplantation.
Main Methods:
- Analysis of U.S. heart transplant data (1994-2006) for patients aged 40+.
- Survival analysis for sCVD impact on stroke, death, and functional decline.
- Logistic regression to identify predictors of perioperative stroke.
Main Results:
- Patients with sCVD had higher rates of stroke or death, stroke, death, and functional decline.
- sCVD increased risk of stroke or death (HR 1.29), stroke (HR 2.24), and functional decline (HR 1.21).
- sCVD, ventilator use, and VAD use predicted perioperative stroke.
Conclusions:
- sCVD patients have increased long-term risk of stroke and functional decline post-transplant.
- No increased mortality risk was identified for sCVD patients.
- Results inform heart transplant program decisions for sCVD candidates.
Objectives:
We sought to determine outcomes in patients with and without symptomatic cerebrovascular disease (sCVD) undergoing heart transplantation. Second, we sought to determine factors associated with stroke in the perioperative period after heart transplantation.
Background:
sCVD is considered a relative contraindication to heart transplantation. Despite this concern, outcomes in patients with sCVD undergoing heart transplantation have not been well defined.
Methods:
Data on all single-organ heart transplants performed in the United States between April 1994 and December 2006 in patients age 40 years or older were analyzed. Survival analysis was performed to examine the effect of sCVD on the combined outcome of stroke or death, stroke, death, and functional decline, adjusting for potential confounding variables over long-term follow-up. In a separate analysis, predictors of perioperative stroke during the transplant-related hospitalization were examined using multiple logistic regression.
Results:
There were 1,078 patients with and 16,765 patients without sCVD. The annualized rates of stroke or death (11.5% vs. 7.8%; p < 0.001), stroke (4% vs. 1.4%; p < 0.001), death (8.9% vs. 7.4%; p < 0.001), and functional decline (3.7% vs. 3.0%; p = 0.002) were higher in patients with sCVD than in patients without sCVD. In multivariable analysis, patients with sCVD were at increased risk of stroke or death (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.17 to 1.42), stroke (HR: 2.24; 95% CI: 2.02 to 2.87), and functional decline (HR: 1.21; 95% CI: 1.03 to 1.42) compared with those without sCVD. We did not identify a higher risk of death in patients with sCVD (HR: 1.08; 95% CI: 0.98 to 1.20), compared with those without sCVD. sCVD, ventilator use, and ventricular assist device use were the most important predictors of perioperative stroke.
Conclusions:
Patients with sCVD are at an increased risk of stroke and functional decline after transplantation independent of other variables, but not death, during long-term follow-up. These results should assist programs in making informed decisions in patients with sCVD who are undergoing evaluation for heart transplantation.
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