Related Experiment Video
Updated: Mar 25, 2026
Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs
Published on: June 23, 2022
Ischemic Stroke after Heart Transplantation
Maurizio Acampa1, Pietro Enea Lazzerini2, Francesca Guideri1
1Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.
Insights
Cerebrovascular complications, including ischemic stroke, are more frequent after heart transplantation than other heart surgeries. Hyperhomocysteinemia and silent atrial fibrillation may contribute to stroke risk in these patients.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Cerebrovascular complications are more common after orthotopic heart transplantation (OHT) compared to routine cardiac surgery.
- Ischemic stroke and transient ischemic attack (TIA) occur in up to 13% of OHT patients, significantly more than intracranial hemorrhage (2.5%).
Purpose of the Study:
- To investigate the distinct mechanisms and risk factors for cerebrovascular complications, particularly ischemic stroke, following OHT.
- To explore the role of silent atrial fibrillation and hyperhomocysteinemia in cryptogenic strokes post-OHT.
Main Methods:
- Review of clinical data and neurological sequelae in OHT patients.
- Analysis of stroke subtypes, incidence, and potential pathogenic mechanisms specific to the perioperative and postoperative periods.
- Correlation of P wave dispersion with homocysteine levels and atrial fibrillation in OHT patients.
Main Results:
- Ischemic stroke is the predominant cerebrovascular complication, with atypical distribution and pathogenic mechanisms compared to general populations.
- A significant proportion (40%) of strokes are cryptogenic, suggesting unidentified underlying causes.
- Silent atrial fibrillation and hyperhomocysteinemia are implicated as potential contributors to stroke pathogenesis, with P wave dispersion as a possible predictor of AF.
Conclusions:
- Stroke is a significant complication of OHT, impacting both mortality and long-term functional outcomes.
- Understanding the unique mechanisms of stroke post-OHT is crucial for risk mitigation.
- Further research into the roles of AF and hyperhomocysteinemia may reveal novel therapeutic targets.
Abstract:
Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%). Clinically, ischemic stroke is manifested by the appearance of focal neurologic deficits, although sometimes a stroke may be silent or manifests itself by the appearance of encephalopathy, reflecting a diffuse brain disorder. Ischemic stroke subtypes distribution in perioperative and postoperative period after OHT is very different from classical distribution, with different pathogenic mechanisms. Infact, ischemic stroke may be caused by less common and unusual mechanisms, linked to surgical procedures and to postoperative inflammation, peculiar to this group of patients. However, many strokes (40%) occur without a well-defined etiology (cryptogenic strokes). A silent atrial fibrillation (AF) may play a role in pathogenesis of these strokes and P wave dispersion may represent a predictor of AF. In OHT patients, P wave dispersion correlates with homocysteine plasma levels and hyperhomocysteinemia could play a role in the pathogenesis of these strokes with multiple mechanisms increasing the risk of AF. In conclusion, stroke after heart transplantation represents a complication with considerable impact not only on mortality but also on subsequent poor functional outcome.
