Gökler Johannes, Aliabadi-Zuckermann Arezu Z, Kaider Alexandra, Ambardekar Amrut V, Antretter Herwig, Artemiou Panagiotis, Bertolotti Alejandro M, Boeken Udo, Brossa Vicens, Copeland Hannah, Generosa Crespo-Leiro Maria, Eixerés-Esteve Andrea, Epailly Eric, Farag Mina, Hulman Michal, Khush Kiran K, Masetti Marco, Patel Jignesh, Ross Heather J, Rudež Igor, Silvestry Scott, Suarez Sofia Martin, Vest Amanda, Zuckermann Andreas O
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.
Front Cardiovasc Med. 2022 Jun 9;10:879612. doi: 10.3389/fcvm.2022.879612. eCollection 2022.
Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports.
We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate.
Data were available from 19 centers in North America ( = 7), South America ( = 1), and Europe ( = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease ( = 62), coronary artery disease (CAD) ( = 16), constrictive pericarditis ( = 17), aortic pathology ( = 13), and myxoma ( = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% ( = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively.
Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.
同种异体移植病理学，如瓣膜、冠状动脉或主动脉疾病，可能在心脏移植后的早期和晚期出现。心脏移植后的心脏手术（CASH）可能是改善生活质量、同种异体移植功能和延长生存期的一种选择。然而，CASH的经验仅限于单中心报告。
我们对1984年1月至2020年12月期间接受CASH的心脏移植受者进行了一项回顾性多中心研究。在本研究中，邀请了60个高容量心脏移植中心参与。
北美有19个中心（n = 7）、南美有1个中心（n = 1）和欧洲有11个中心（n = 11）提供了数据，共有110例患者。每个中心报告的手术中位数为3次（IQR 2 - 8.5）；5个中心纳入了≥10例患者。CASH的适应证为瓣膜疾病（n = 62）、冠状动脉疾病（CAD）（n = 16）、缩窄性心包炎（n = 17）、主动脉病变（n = 13）和黏液瘤（n = 2）。CASH时的年龄中位数为57.7（47.8 - 63.1）岁，从移植到CASH的时间中位数为4.4（1 - 9.6）年。24.5%的患者在移植后第一年内进行了再次手术。住院死亡率为9.1%（n = 10）。1年生存率为86.2%，中位随访时间为8.2（3.8 - 14.6）年。最常见的围手术期并发症分别是急性肾损伤和出血修正，发生率分别为18%和9.1%。
在精心挑选的患者中，心脏移植后的心脏手术住院死亡率和术后并发症较低。CASH的发生率和类型在国际中心之间有所不同。预后较差的危险因素是较高的欧洲心脏手术风险评估系统（EuroSCORE II）和术后肾衰竭。
