The surgical anastomoses after orthotopic heart transplantation: clinical complications and morphologic observations

Area of Science:

• Cardiovascular Surgery
• Transplantation Medicine
• Pathology

Background:

• Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
• Surgical anastomoses are critical for transplant success but can be associated with complications.
• Limited literature exists describing specific postmortem findings of heart transplant anastomoses.

Observation:

• A retrospective analysis of 29 postmortem examinations from 162 orthotopic heart transplant patients was conducted.
• The study focused on the surgical anastomoses of the transplanted hearts.
• Various anastomotic complications were identified and documented.

Findings:

• Stenosis at the left atrial anastomosis (2 cases).
• Aortic anastomotic tear (1 case).
• Pulmonary artery anastomotic kinking (1 case).
• Left atrial suture line mural thrombus with possible coronary embolism (1 case).
• Extramural compression of a coronary artery by an anastomotic suture (1 case).
• Other findings included residual native valve remnants, tissue tags, mural thrombi, and protruding suture ends.

Implications:

• These findings underscore the importance of meticulous surgical technique in heart transplantation.
• Identifying and addressing anastomotic complications can potentially improve long-term patient outcomes.
• Further research into optimizing anastomotic techniques is warranted to reduce transplant-related morbidity.