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Neurologic complications of cardiac transplantation
B T Andrews1, J J Hershon, P Calanchini
1Department of Neurological Surgery, Pacific Presbyterian Medical Center, San Francisco, CA.
Insights
Orthotopic cardiac transplantation carries a low risk of acute neurologic events. Complications like stroke or hemorrhage can occur, with drug toxicity being the only direct procedural link.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- End-stage congestive cardiomyopathy necessitates advanced treatments.
- Orthotopic cardiac transplantation is a viable option for refractory cases.
- Neurologic complications following cardiac transplantation require careful evaluation.
Purpose of the Study:
- To assess the incidence and nature of acute neurologic events after orthotopic cardiac transplantation.
- To identify potential causes and outcomes of neurologic complications in transplant recipients.
Main Methods:
- Retrospective analysis of 90 orthotopic cardiac transplantations performed between 1984 and 1989.
- Review of patient records for perioperative and postoperative neurologic events.
- Categorization of neurologic events including cerebral infarction and intracerebral hemorrhage.
Main Results:
- Six patients (7%) experienced acute neurologic events perioperatively.
- Cerebral infarctions occurred pre- and post-transplantation, with embolic origin suspected postoperatively.
- Intracerebral hemorrhages were observed post-transplantation, associated with hypertension and other comorbidities.
- One case of cyclosporine toxicity manifested as tremor, seizures, and altered consciousness.
- One death resulted from intracerebral hemorrhage; recovery varied among affected patients.
Conclusions:
- Acute neurologic insults following orthotopic cardiac transplantation are infrequent.
- Potential causes include drug toxicity, cerebral ischemia, and hemorrhagic mechanisms.
- Careful patient selection and monitoring are crucial to mitigate neurologic risks.
Abstract:
Between 1984 and 1989, orthotopic cardiac transplantations were done in 90 patients from 10 to 65 years of age for end-stage, refractory congestive cardiomyopathy. Two patients had had ischemic strokes 5 months and 18 years, respectively, before transplantation. Six patients (7%) suffered acute neurologic events perioperatively. Three patients suffered cerebral infarctions. In 1 case this occurred 10 days before transplantation--probably as a result of systemic hypoperfusion--with the placement of ventricular assist devices. Two others suffered infarctions 5 and 21 days, respectively, after transplantation, each of probable embolic origin. Two patients had an acute intracerebral hemorrhage 21 and 36 days, respectively, after transplantation; both were located within the basal ganglia and subcortical regions. Both patients had moderate to severe hypertension, and in 1, renal failure and a coagulopathy developed before hemorrhage. Tremor, seizures, and an altered level of consciousness developed in 1 patient as an apparent toxic reaction to cyclosporine treatment. Only 1 patient died as a result of the neurologic complication--of an acute intracerebral hemorrhage. Three patients recovered fully, 2 partially. Only the case of drug toxicity could be directly attributed to the transplantation procedure itself. We conclude that the risk of an acute neurologic insult with orthotopic cardiac transplantation is low but may result from drug toxicity, cerebral ischemia, or hemorrhagic mechanisms.