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

Johannes Gökler; Arezu Z Aliabadi-Zuckermann; Alexandra Kaider; Amrut V Ambardekar; Herwig Antretter; Panagiotis Artemiou; Alejandro M Bertolotti; Udo Boeken; Vicens Brossa; Hannah Copeland; Maria Generosa Crespo-Leiro; Andrea Eixerés-Esteve; Eric Epailly; Mina Farag; Michal Hulman; Kiran K Khush; Marco Masetti; Jignesh Patel; Heather J Ross; Igor Rudež; Scott Silvestry; Sofia Martin Suarez; Amanda Vest; Andreas O Zuckermann

doi:10.3389/fcvm.2022.879612

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

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

Authors

Johannes Gökler¹, Arezu Z Aliabadi-Zuckermann¹, Alexandra Kaider², Amrut V Ambardekar³, Herwig Antretter⁴, Panagiotis Artemiou⁵, Alejandro M Bertolotti⁶, Udo Boeken⁷, Vicens Brossa⁸, Hannah Copeland⁹, Maria Generosa Crespo-Leiro¹⁰, Andrea Eixerés-Esteve¹¹, Eric Epailly¹², Mina Farag¹³, Michal Hulman⁵, Kiran K Khush¹⁴, Marco Masetti¹⁵, Jignesh Patel¹⁶, Heather J Ross¹⁷, Igor Rudež¹⁸, Scott Silvestry¹⁹, Sofia Martin Suarez²⁰, Amanda Vest²¹, Andreas O Zuckermann¹

Affiliations

¹ Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
² Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.
³ Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States.
⁴ Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
⁵ National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia.
⁶ Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina.
⁷ Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany.
⁸ Heart Transplant Division, Hospital Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain.
⁹ Division Cardiac Surgery, Lutheran Hospital, Indiana University School of Medicine, Indiana, IA, United States.
¹⁰ Complejo Hospitalario Universitario a Coruña (CHUAC), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), La Coruña, Spain.
¹¹ Department of Cardiac Surgery, University Hospital 12 de Octubre, Madrid, Spain.
¹² Heart and Heart-Lung Transplant Unit Medical, Department of Cardiovascular Surgery, Les Hôpitaux Universitaires NHC, Strasbourg, France.
¹³ Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
¹⁴ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States.
¹⁵ Heart Failure and Heart Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy.
¹⁶ Heart Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
¹⁷ Cardiac Transplant Program, Peter Munk Cardiac Centre, Toronto, ON, Canada.
¹⁸ Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia.
¹⁹ Thoracic Transplant Program, AdventHealth Transplant Institute, Florida, FL, United States.
²⁰ Cardiac Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy.
²¹ Cardiac Transplantation Program, Tufts Medical Center, Boston, MA, United States.

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.

Copyright © 2022 Gökler, Aliabadi-Zuckermann, Kaider, Ambardekar, Antretter, Artemiou, Bertolotti, Boeken, Brossa, Copeland, Generosa Crespo-Leiro, Eixeré-Esteve, Epailly, Farag, Hulman, Khush, Masetti, Patel, Ross, Rudež, Silvestry, Suarez, Vest and Zuckermann.