Extracardiac surgical complications in heart transplant recipients

As the population of patients undergoing orthotopic heart transplantation increases, more patients are likely to develop surgical complications unrelated to the transplant procedure. This article reviews 38 extracardiac surgical complications sustained in 18 of 48 patients undergoing orthotopic heart transplantation at our institution over a 4-year period. Twenty-seven complications (71.1%) required operative intervention most commonly in an urgent or emergent manner (59.3%). Three patients underwent six laparotomies. Infection was the cause in almost half of all complications and in 65% of those requiring surgery. Gastrointestinal hemorrhage was common and successfully managed nonoperatively in all cases. The overall operative mortality was 11% with only two deaths related to a surgical complication. The satisfactory outcome in these patients can be attributed to the early diagnosis of complications, timely therapeutic intervention, careful adjustment of immunosuppressive agents, and close patient follow-up with the transplant institution.