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. 2022 Jun 9:10:879612.
doi: 10.3389/fcvm.2022.879612. eCollection 2022.

Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study

Johannes Gökler  1 , Arezu Z Aliabadi-Zuckermann  1 , Alexandra Kaider  2 , Amrut V Ambardekar  3 , Herwig Antretter  4 , Panagiotis Artemiou  5 , Alejandro M Bertolotti  6 , Udo Boeken  7 , Vicens Brossa  8 , Hannah Copeland  9 , Maria Generosa Crespo-Leiro  10 , Andrea Eixerés-Esteve  11 , Eric Epailly  12 , Mina Farag  13 , Michal Hulman  5 , Kiran K Khush  14 , Marco Masetti  15 , Jignesh Patel  16 , Heather J Ross  17 , Igor Rudež  18 , Scott Silvestry  19 , Sofia Martin Suarez  20 , Amanda Vest  21 , Andreas O Zuckermann  1
Affiliations

Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study

Johannes Gökler et al. Front Cardiovasc Med. .

Abstract

Background: 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.

Methods: 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.

Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 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 (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 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% (n = 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.

Conclusion: 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.

Keywords: cardiac retransplantation; cardiac surgery; cardiac transplantation; heart failure; heart transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) A 3-year survival for patients with cardiac surgery after heart transplantation (CASH). (B) A 3-year survival according to the different indications for CASH. (C) A 3-year survival in patients with urgent and elective indication for CASH.
See this image and copyright information in PMC

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