Goekler Johannes, Zuckermann Andreas, Osorio Emilio, Brkic Faris F, Uyanik-Uenal Keziban, Laufer Guenther, Aliabadi-Zuckermann Arezu
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Transplant Direct. 2017 Sep 9;3(10):e209. doi: 10.1097/TXD.0000000000000725. eCollection 2017 Oct.
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.
In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution.
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).
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.
由于心脏移植（HTx）后长期生存率有所提高，诸如瓣膜疾病或心脏移植血管病变（CAV）等晚期移植病理可能需要手术干预以提高生存率并确保生活质量。迄今为止，除了HTx后的再次移植外，尚无心脏手术指征的指南。
在这项回顾性单中心研究中，我们评估了在我们机构接受HTx后进行心脏手术的患者。
1984年3月至2016年10月期间，1466例HTx患者中有17例（1.16%）在HTx后接受了除再次移植以外的心脏手术。指征包括瓣膜疾病（n = 7）、CAV（n = 6）和其他（n = 4）。其中，29.4%（n = 5）为急诊手术，70.6%为择期手术。手术时的中位年龄为61岁（四分位间距，52 - 66岁）；82.4%（n = 14）为男性。HTx后至手术的中位时间为9.3年（2.7 - 11.1年）。住院死亡率为11.8%（n = 2）；术后3至9个月因CAV进展，后期再次移植的需求为11.8%（n = 2）。1年生存率为82.35%；总体生存率为47.1%（n = 8），中位随访时间为1477天（416 - 2135天）。急诊手术后的总体生存时间为209天（36 - 1119.5天），而择期手术后为1583.5天（901.5 - 4319天）。
与其他研究相比，我们队列中HTx后心脏手术的发生率较低（1.16%）。在择期病例中，长期生存率良好。
