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Cuko B, Baudo M, Busuttil O, Taymoor S, Nubret K, Lafitte S, Beurton A, Ouattara A, De Vincentiis C, Modine T, Labrousse L, Pernot M. Outcomes of left-sided heart valve surgery after heart transplantation: a systematic review. Heart Fail Rev 2024; 29:227-234. [PMID: 37950833 DOI: 10.1007/s10741-023-10368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
As the survival after heart transplantation (HTx) is steadily improving, an increasing number of patients with late cardiac pathologies such as valvular disease is expected to rise. Nevertheless, no guidelines for indication of redo cardiac surgery after HTx exists. The aim of the present systematic review is to describe the results reported in the literature of surgical management of severe aortic and/or mitral valve disease. A systematic review was conducted including studies reporting on adult patients with severe mitral or aortic valve pathology needing surgery after their previous HTx. Exclusion criteria consisted in surgery with no left heart valve surgery, concomitant valve surgery during heart transplant, transcatheter interventions, and heterotopic HTx. A total of 35 papers met our inclusion criteria out of 2755 potentially eligible studies with 44 mitral valve surgery patients and 20 aortic valve surgery patients. In the entire population, the mean time from HTx to reintervention was 6.19 ± 5.22 years. After a mean follow-up of 2.78 ± 3.54 years and 1.53 ± 2.26 years from reintervention, 65.6% mitral and 86.7% aortic patients were reported as alive, respectively. As guidelines on cardiac surgery after HTx are currently lacking, left-sided valvular cardiac reinterventions can be considered a possible therapeutic approach in carefully selected patients. These interventions may not only improve the patient's functional status and survival, but may ultimately reduce the need for re-transplantation due to the chronic shortage of donor hearts. However, the support of more robust data is warranted.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France.
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
- Department of Cardiac Surgery, University Hospitals Leuven, Louvain, Belgium
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Saud Taymoor
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Karine Nubret
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Stephane Lafitte
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | | | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Av. Magellan, Pessac, 33604, France
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Gökler J, Aliabadi-Zuckermann AZ, Kaider A, Ambardekar AV, Antretter H, Artemiou P, Bertolotti AM, Boeken U, Brossa V, Copeland H, Generosa Crespo-Leiro M, Eixeré-Esteve A, Epailly E, Farag M, Hulman M, Khush KK, Masetti M, Patel J, Ross HJ, Rudež I, Silvestry S, Suarez SM, Vest A, Zuckermann AO. Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study. Front Cardiovasc Med 2022; 10:879612. [PMID: 35756840 PMCID: PMC9218180 DOI: 10.3389/fcvm.2022.879612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Johannes Gökler,
| | | | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Herwig Antretter
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Alejandro M. Bertolotti
- Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Vicens Brossa
- Heart Transplant Division, Hospital Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Hannah Copeland
- Division Cardiac Surgery, Lutheran Hospital, Indiana University School of Medicine, Indiana, IA, United States
| | - Maria Generosa Crespo-Leiro
- Complejo Hospitalario Universitario a Coruña (CHUAC), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), La Coruña, Spain
| | | | - Eric Epailly
- Heart and Heart-Lung Transplant Unit Medical, Department of Cardiovascular Surgery, Les Hôpitaux Universitaires NHC, Strasbourg, France
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Kiran K. Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Jignesh Patel
- Heart Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Heather J. Ross
- Cardiac Transplant Program, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Igor Rudež
- Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Scott Silvestry
- Thoracic Transplant Program, AdventHealth Transplant Institute, Florida, FL, United States
| | - Sofia Martin Suarez
- Cardiac Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Amanda Vest
- Cardiac Transplantation Program, Tufts Medical Center, Boston, MA, United States
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Kremer J, Al-Maisary SSA, Szabó G. A Clean Cut: Minimally Invasive Mitral Valve Replacement after Heart Transplantation. Thorac Cardiovasc Surg Rep 2019; 8:e27-e29. [PMID: 31440439 PMCID: PMC6703990 DOI: 10.1055/s-0039-1693451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/30/2019] [Indexed: 11/15/2022] Open
Abstract
A 50-year-old female presented with progressive heart failure due to obstruction of the mitral valve after heart transplantation in 2008. Through the occlusion catheter (IntraClude Intra-Aortic Occlusion Device), aortic cross-clamping, antegrade cardioplegia, and aortic root venting were performed. Our case reports the first published study on minimally invasive mitral valve replacement for valve stenosis through intraluminal aortic clamping. The hazard of traumatic injuries can be reduced by avoiding resternotomy and circumventing adhesions between the aorta and the pulmonary artery after heart transplantation. Minimally invasive valve surgery is a safe and effective method with regard to short- and long-term results, especially in redo operations.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
| | | | - Gábor Szabó
- Department of Cardiac Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
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Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? Transplant Direct 2017; 3:e209. [PMID: 29138760 PMCID: PMC5627740 DOI: 10.1097/txd.0000000000000725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background 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. Methods In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution. Results 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). Conclusions 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.
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Raza FS, Grayburn PA, Choi JW. Use of a MitraClip for severe mitral regurgitation in a cardiac transplant patient. Proc (Bayl Univ Med Cent) 2017; 30:226-227. [PMID: 28405092 DOI: 10.1080/08998280.2017.11929597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Severe mitral regurgitation (MR) in patients after cardiac transplant has not been well studied. Traditionally, patients have undergone corrective surgery. We report a 64-year-old man who presented with new heart failure symptoms 6 months after cardiac transplantation. He was found to have severe MR and underwent successful implantation of a MitraClip® with reduction of his MR to mild as well as improvement in his symptoms. Six months later he was still doing well, and a repeat echocardiogram showed good results. We found two previously reported cases using the MitraClip to treat severe MR in adult cardiac transplant patients. The MitraClip is a viable treatment option for MR in cardiac transplant patients despite their distorted anatomy.
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Affiliation(s)
- Fayez S Raza
- Baylor Heart and Vascular Hospital, Dallas, Texas
| | | | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas
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Martens T, Caes F, De Pauw M, Hens L, Bove T. Minimally Invasive Repair of Mitral Valve Prolapse and Concomitant Atrial Fibrillation Ablation in a Heart Transplant. Ann Thorac Surg 2016; 102:e305-7. [PMID: 27645968 DOI: 10.1016/j.athoracsur.2016.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/14/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
Significant mitral valve disease with atrial fibrillation after heart transplantation is unusual. We report the diagnosis and minimally invasive surgical treatment 17 years after transplantation, in which mitral valve repair together with left atrial ablation was performed, resulting in a satisfying clinical and echocardiographic improvement.
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Affiliation(s)
- Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Frank Caes
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Lineke Hens
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
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Bouma W, Brügemann J, Hamer IJWD, Klinkenberg TJ, Koene BM, Kuijpers M, Erasmus ME, van der Horst IC, Mariani MA. Mitral valve repair and redo repair for mitral regurgitation in a heart transplant recipient. J Cardiothorac Surg 2012; 7:100. [PMID: 23020892 PMCID: PMC3503642 DOI: 10.1186/1749-8090-7-100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 09/23/2012] [Indexed: 11/15/2022] Open
Abstract
A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation) may not only improve the patient’s functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts.
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Affiliation(s)
- Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
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