Alejaldre Aída, Delgado-Mederos Raquel, Santos Miguel Ángel, Martí-Fàbregas Joan
Stroke Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Spain.
Curr Cardiol Rev. 2010 Aug;6(3):214-7. doi: 10.2174/157340310791658811.
Neurological complications in orthotopic heart transplantation represent a major cause of morbidity and mortality despite successful transplantation. The most frequent perioperative neurological complications are delirium or encephalopathy. In this period cerebrovascular complication ranges between 5-11%. After the perioperative period, the 5-year stroke risk after cardiac transplantation is 4.1%. In a retrospective study conducted with 314 patients who underwent cardiac transplantation, it was found that 20% of cerebrovascular complications occurred within the first two weeks after transplantation, while 80% occurred in the late postoperative phase. Of these, ischemic stroke is the most common subtype. In the perioperative periode, hemodynamic instability, cardiac arrest, extracorporeal circulation over 2 hours, prior history of stroke, and carotid stenosis greater than 50% have been reported to be risk factors for the occurrence of cerebrovascular complications. Perioperative cerebrovascular complications are associated with higher mortality and poor functional outcome at one year follow-up.After the perioperative period, the only factor that has been significantly associated with an increased risk of cerebrovascular complications is a history of prior stroke, either ischemic or hemorrhagic. Other associated factors include unknown atrial fibrillation, septic emboli from endocarditis, cardiac catheterization and perioperative hemodynamic shock. According to the TOAST etiologic classification, the most prevalent etiologic subtype of ischemic stroke is undetermined cause.
尽管原位心脏移植手术成功，但神经并发症仍是发病和死亡的主要原因。围手术期最常见的神经并发症是谵妄或脑病。在此期间，脑血管并发症的发生率在5%-11%之间。围手术期过后，心脏移植术后5年的中风风险为4.1%。在一项对314例接受心脏移植手术的患者进行的回顾性研究中发现，20%的脑血管并发症发生在移植后的前两周内，而80%发生在术后晚期。其中，缺血性中风是最常见的亚型。在围手术期，血流动力学不稳定、心脏骤停、体外循环超过2小时、既往中风史以及颈动脉狭窄超过50%被报道为发生脑血管并发症的危险因素。围手术期脑血管并发症与较高的死亡率以及一年随访时不良的功能结局相关。围手术期过后，与脑血管并发症风险增加显著相关的唯一因素是既往中风史，无论是缺血性还是出血性。其他相关因素包括不明原因的心房颤动、感染性心内膜炎的脓毒性栓子、心脏导管插入术以及围手术期血流动力学休克。根据TOAST病因分类，缺血性中风最常见的病因亚型是病因不明。
