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General surgical complications in heart and heart-lung transplantation
Insights
General surgical complications occurred in 28% of cardiac transplant patients, with many requiring surgery or dying from unrecognized issues. Early diagnosis and surgical technique are crucial for managing these complex cases.
Area of Science:
- Cardiovascular Surgery
- Transplant Surgery
- Gastrointestinal Surgery
Background:
- Cardiac transplantation, including heart, heart-lung, and heart-liver procedures, has been performed since 1980.
- Immunosuppression regimens commonly include prednisone and cyclosporine.
Purpose of the Study:
- To analyze the incidence and nature of general surgical complications following cardiac transplantation.
- To highlight the importance of surgical management in transplant recipients.
Main Methods:
- Retrospective review of 143 patients who underwent cardiac transplantation between 1980 and 1985.
- Analysis of surgical complications, interventions, and outcomes.
Main Results:
- 28% of patients (40/143) experienced general surgical complications.
- 17 patients required surgical intervention, including laparotomy, hernia repair, and abscess drainage.
- Six patients died from unrecognized surgical complications, such as pancreatitis and bowel perforation.
Conclusions:
- General surgical complications are a significant concern after cardiac transplantation, affecting 28% of patients.
- Effective management requires prompt diagnosis, skilled surgical technique, and careful immunosuppression management.
- The general surgeon plays a vital role in the care of these complex transplant patients.
Abstract:
One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.