Key result
Subsequent cardiac surgery in heart transplant recipients shows comparable 10-year survival to the overall cohort.
Why the study?
With improving post-transplant survival and increased use of extended donor criteria, the risk of heart transplant recipients developing cardiac pathology requiring surgical correction is increasing.
Does subsequent cardiac surgery result in acceptable survival in heart transplant recipients compared to the overall transplant cohort?
Cohort (n=479)
No
Does subsequent cardiac surgery result in acceptable survival in heart transplant recipients compared to the overall transplant cohort?
Redo cardiac surgery in heart transplant recipients, primarily for atrioventricular valve pathology, can be performed with acceptable mortality and long-term survival comparable to the general transplant cohort.
Subsequent cardiac surgery remains infrequent post-transplant; leaves open the impact of extended donor criteria on reoperation risk.
BACKGROUND: Survival rates following cardiac transplantation continue to improve. Due to the scarcity of available organs, extended donor criteria have become more prevalent in clinical practice. In this context, the risk of developing cardiac pathology requiring surgical correction is increasing. METHODS: Between January 1991 and October 2010, a total of 479 patients received cardiac transplantations at the University Hospital Heidelberg. Of those, 18 (3.8%) patients required subsequent cardiac surgery until 2018. Short- and long-term analyses were performed. RESULTS: Indications for cardiac surgery included valvular disease (n = 16) with the majority of cases affecting the tricuspid valve (n = 10), while 6 patients received mitral valve surgery, of whom 3 patients underwent concomitant valve surgery. Other indications included CABG (n = 1) and re-transplantation (n = 1) for allograft dysfunction. Mean follow-up time was 6.5 years, while mean interval to surgery was 6.0 years. Early mortality was 11.1% (n = 2), while overall survival at 1, 5, and 10 years were, 88.1%, 81.4%, and 52.2%, respectively. Compared to an overall survival of that transplant cohort at 1, 5, and 10 years of 76.7%, 66.7%, and 52.4% percent, respectively (P = .271). CONCLUSION: According to our data, redo cardiac surgery can be performed with acceptable mortality and morbidity. Atrioventricular valve pathology plays a chief role in these patients.
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Farag et al. (2019) conducted a cohort in Heart transplant recipients (n=479). Subsequent cardiac surgery vs. Overall transplant cohort was evaluated on Overall survival at 10 years (p=0.271). Subsequent cardiac surgery in heart transplant recipients resulted in a 10-year overall survival of 52.2%, comparable to the 52.4% survival seen in the overall transplant cohort (P=0.271).
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