Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy?
Background. Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guideline...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2017-10-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000725 |
| _version_ | 1818534992915988480 |
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| author | Johannes Goekler, MD Andreas Zuckermann, MD Emilio Osorio, MD Faris F. Brkic, MD Keziban Uyanik-Uenal, MD Guenther Laufer, MD Arezu Aliabadi-Zuckermann, MD |
| author_facet | Johannes Goekler, MD Andreas Zuckermann, MD Emilio Osorio, MD Faris F. Brkic, MD Keziban Uyanik-Uenal, MD Guenther Laufer, MD Arezu Aliabadi-Zuckermann, MD |
| author_sort | Johannes Goekler, MD |
| collection | DOAJ |
| description | Background. Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx.
Methods. In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution.
Results. Between March 1984 and October 2016, 17 (1.16%) of 1466 HTx patients underwent cardiac surgery other than retransplantation after HTx. Indication were valvular disease (n = 7), CAV (n = 6), and other (n = 4). Of these, 29.4% (n = 5) were emergency procedures and 70.6% were elective cases. Median age at time of surgery was 61 years (interquartile range, 52-66 years); 82.4% (n = 14) were male. Median time to surgery after HTx was 9.3 years (2.7-11.1 years). In-hospital, mortality was 11.8% (n = 2); later need of retransplantation was 11.8% (n = 2) due to progressing CAV 3 to 9 months after surgery. One-year survival was 82.35%; overall survival was 47.1% (n = 8) with a median follow-up of 1477 days (416-2135 days). Overall survival after emergency procedures was 209 days (36-1119.5 days) whereas, for elective procedures, it was 1583.5 days (901.5-4319 days).
Conclusions. Incidence of cardiac surgery after HTx in our cohort was low (1.16%) compared with that of other studies. In elective cases, long-term survival was good. |
| first_indexed | 2024-12-11T18:18:53Z |
| format | Article |
| id | doaj.art-6f32d69f577642cc89261bc7c3bca654 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-11T18:18:53Z |
| publishDate | 2017-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-6f32d69f577642cc89261bc7c3bca6542022-12-22T00:55:20ZengWolters KluwerTransplantation Direct2373-87312017-10-01310e20910.1097/TXD.0000000000000725201710000-0007Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy?Johannes Goekler, MD0Andreas Zuckermann, MD1Emilio Osorio, MD2Faris F. Brkic, MD3Keziban Uyanik-Uenal, MD4Guenther Laufer, MD5Arezu Aliabadi-Zuckermann, MD61 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.Background. Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx. Methods. In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution. Results. Between March 1984 and October 2016, 17 (1.16%) of 1466 HTx patients underwent cardiac surgery other than retransplantation after HTx. Indication were valvular disease (n = 7), CAV (n = 6), and other (n = 4). Of these, 29.4% (n = 5) were emergency procedures and 70.6% were elective cases. Median age at time of surgery was 61 years (interquartile range, 52-66 years); 82.4% (n = 14) were male. Median time to surgery after HTx was 9.3 years (2.7-11.1 years). In-hospital, mortality was 11.8% (n = 2); later need of retransplantation was 11.8% (n = 2) due to progressing CAV 3 to 9 months after surgery. One-year survival was 82.35%; overall survival was 47.1% (n = 8) with a median follow-up of 1477 days (416-2135 days). Overall survival after emergency procedures was 209 days (36-1119.5 days) whereas, for elective procedures, it was 1583.5 days (901.5-4319 days). Conclusions. Incidence of cardiac surgery after HTx in our cohort was low (1.16%) compared with that of other studies. In elective cases, long-term survival was good.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000725 |
| spellingShingle | Johannes Goekler, MD Andreas Zuckermann, MD Emilio Osorio, MD Faris F. Brkic, MD Keziban Uyanik-Uenal, MD Guenther Laufer, MD Arezu Aliabadi-Zuckermann, MD Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? Transplantation Direct |
| title | Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? |
| title_full | Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? |
| title_fullStr | Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? |
| title_full_unstemmed | Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? |
| title_short | Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? |
| title_sort | cardiac surgery after heart transplantation elective operation or last exit strategy |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000725 |
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