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Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study

Johannes Gökler1, Arezu Z Aliabadi-Zuckermann1, Alexandra Kaider2

  • 1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

Frontiers in Cardiovascular Medicine
|June 27, 2022
PubMed

Insights

Cardiac surgery after heart transplantation (CASH) is safe for carefully selected patients, showing low in-hospital mortality and manageable complications. This multicenter study highlights the varying incidence and types of CASH globally, with higher EuroSCORE II and renal failure indicating worse outcomes.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Cardiac Surgery

Background:

  • Allograft pathologies like valvular, coronary artery, or aortic disease can occur post-cardiac transplantation.
  • Cardiac surgery after heart transplantation (CASH) may improve quality of life, allograft function, and survival.
  • Limited single-center data exists on the experience and outcomes of CASH.

Purpose of the Study:

  • To evaluate the safety and outcomes of cardiac surgery after heart transplantation (CASH) in a multicenter setting.
  • To identify indications, complications, and survival rates associated with CASH.
  • To explore variations in CASH incidence and types across international centers.

Main Methods:

  • Retrospective, multicenter study of heart transplant recipients undergoing CASH between January 1984 and December 2020.
  • Data collected from 19 participating high-volume cardiac transplant centers across North America, South America, and Europe.
  • Analysis included patient demographics, indications for surgery, time from transplant, perioperative complications, and survival.

Main Results:

  • A total of 110 patients underwent CASH, with valvular disease being the most common indication (n=62).
  • In-hospital mortality was 9.1%, with 1-year survival at 86.2% and a median follow-up of 8.2 years.
  • Frequent complications included acute kidney injury (18%) and bleeding revision (9.1%); higher EuroSCORE II and postoperative renal failure were associated with worse outcomes.

Conclusions:

  • Cardiac surgery after heart transplantation demonstrates low in-hospital mortality and acceptable postoperative complications in carefully selected patients.
  • Significant international variation exists in the incidence and types of CASH performed.
  • Higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure are risk factors for adverse outcomes.
Abstract

Keywords:
cardiac retransplantationcardiac surgerycardiac transplantationheart failureheart transplantation

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