Abstract
Surgical complications following heart transplantation include a wide variety of clinical scenarios that can occur intraoperatively, early after surgery or even years following transplantation. An increasing number of patients are at risk of surgical injuries and bleeding complications as more patients are currently being bridged to transplantation with durable mechanical support devices and therefore have a history of prior sternotomies and are anticoagulated. CT imaging of the chest, optimal anticoagulation reversal, careful operative planning, and meticulous surgical technique are very important tools to prevent catastrophic complications or life-threatening bleeding. Primary and secondary graft dysfunction is common after heart transplantation and one of the most important causes of death within the first year. Although the initial therapeutic strategies include inotropes, vasopressors, and pulmonary vasodilators, many patients require temporary mechanical support to rest the heart and allow graft recovery. Other less common acute and chronic complications are also discussed in this chapter including aortic complications, heart oversizing, wound infections, pericardial effusions, constrictive pericarditis, and tricuspid regurgitation.
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References
Abid Q et al (2003) Mediastinitis in heart and lung transplantation: 15 years experience. Ann Thorac Surg 75:1565–1571
Al-Dadah AS et al (2007) Clinical course and predictors of pericardial effusion following cardiac transplantation. Transplant Proc 39:1589–1592
Audenaert T et al (2015) Type B aortic dissection triggered by heart transplantation in a patient with Marfan syndrome. BMJ Case Report. https://doi.org/10.1136/bcr-2015-211138
Aziz T et al (1999) Bicaval and standard techniques in orthotopic heart transplantation: medium- term experience in cardiac performance and survival. J Thorac Cardiovasc Surg 118:115–122
Bergenfeldt H et al (2017) Donor-recipient size matching and mortality in heart transplantation: influence of body mass index and gender. J Heart Lung Transplant 36:940–994
Bertog S et al (2004) Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 43:1445–1452
Bouzas-Mosquera A et al (2008) Adverse effects of mammalian target of rapamycin inhibitors during the postoperative period after cardiac transplantation. Transplant Proc 40:3027–3030
Burkhoff et al (2015) Hemodynamics of mechanical circulatory Support. J Am Coll Cardiol 66:2663–2674
Carrier M et al (1994) Mediastinal and pericardial complications after heart transplantation: not-so-unusual postoperative problems? Cardiovasc Surg 2(3):395–397
Carrier M et al (2001) Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment. Ann Thorac Surg 72:719–724
Ciliberto GR et al (1995) Significance of pericardial effusion after heart transplantation. Am J Cardiol 76:297–300
Costanzo MR et al (2010) The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 29:914–956
D’Alessandro C et al (2010) Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. Eur J Cardiothorac Surg 37:343–349
Davies RR et al (2010) Standard versus bicaval techniques for orthotopic heart transplantation: an analysis of the united network for organ sharing database. J Thorac Cardiovasc Surg 140:700–708
Filsoufi F et al (2007) Incidence, treatment strategies and outcome of deep sternal wound infection after orthotopic heart transplantation. J Heart Lung Transplant 26:1084–1090
George RS et al (2006) Acinetobacter mediastinitis in a heart transplant patient. Ann Thorac Surg 82:715–716
Hauptman PJ et al (1994) Pericardial effusions after cardiac transplantation. J Am Coll Cardiol 23:1625–1629
Hong KN et al (2011) Who is the high-risk recipient? Predicting mortality after heart transplant using pretransplant donor and recipient risk factors. Ann Thorac Surg 92:520–527
Imran Hamid U et al (2015) Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg 47:819–823
Iyer A et al (2011) Primary graft failure after heart transplantation. J Transp Secur 2011:175768
Jahangirifard A et al (2017) Prophylactic fibrinogen decreases postoperative bleeding but not acute kidney injury in patients undergoing heart transplantation. Clin Appl Thromb Hemost 24:998. https://doi.org/10.1177/1076029617731625
Jeevanandam V et al (2006) Donor tricuspid annuloplasty during orthotopic heart transplantation: long-term results of a prospective controlled study. Ann Thorac Surg 82:2089–2095
Kaczorowski D et al (2013) Profound hyperacute cardiac allograft rejection rescue with biventricular mechanical circulatory support and plasmapheresis, intravenous immunoglobulin, and rituximab therapy. J Cardiothorac Surg 8:48
Kedziora A et al (2016) Impact of postoperative bleeding on short-term outcome in patients after orthotopic heart transplantation: a retrospective cohort study. Ann Transplant 21:689–694
Kennel A et al (2012) Fatal peri-operative hyperacute raft rejection during heart transplantation related to infusion of red blood cell concentrate. J Heart Lung Transplant 31:1230–1233
Kim HJ et al (2013) Early postoperative complications after heart transplantation in adult recipients: Asan medical center experience. Korean J Thorac Cardiovasc Surg 46:426–432
Kim YS et al (2016) Prolonged pericardial drainage using soft drain reduces pericardial effusion and need for additional pericardial drainage following orthotopic heart transplant. Eur J Cardiothorac Surg 49:818–822
Kobashigawa J et al (2014) Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 33:327–340
Kristensen KL et al (2012) Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg 14:709–713
Kumar R et al (2008) Constrictive pericarditis after cardiac transplantation: a case report and literature review. J Heart Lung Transplant 27(10):1158–1161
LaPar DJ et al (2013) A protocol-driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy. Ann Thorac Surg 96:865–870
Lund LH et al (2017) The registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult heart transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant 36:1037–1046
Marasco SF et al (2012) Impact of warm ischemia time on survival after heart transplantation. Transplant Proc 44:1385–1389
Patane F et al (2009) Mycotic pseudoaneurysm as aortic complication after heart transplantation. Transpl Int 22:943–944
Quin JA et al (2002) Predictors of pericardial effusion after orthotopic heart transplantation. J Thorac Cardiovasc Surg 124:979–983
Raghavan R et al (2006) Tricuspid valve replacement after cardiac transplantation. Clin Transpl 20:673–676
Russo MJ et al (2010) Factors associated with primary graft failure after heart transplantation. Transplantation 90:444–450
Sabatino et al (2017) Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: epidemiology, risk factors, and outcomes. J Heart Lung Transplant 36:1217–1225
Segovia J et al (2011) RADIAL: a novel primary graft failure risk score in heart transplantation. J Heart Lung Transplant 30:644–651
Senechal M et al (2004) Bacterial Mediastinitis after heart transplantation: clinical presentation, risk factors and treatment. J Heart Lung Transplant 23:165–170
Urbanowicz T et al (2015) EuroSCORE is a predictor of postoperative pericardial effusion following heart transplantation. Ann Transplant 20:193–197
Vigano M et al (1999) The spectrum of aortic complications after heart transplantation. Ann Thorac Surg 68:105–111
Wagner FM et al (2013) Additional intraoperative blood cardioplegia to improve donor heart ischemic tolerance – a single center prospective cohort study. Thorac Cardiovasc Surg 61:OP127
Wierzbicki K et al (2016) Life-threatening cardiac tamponade secondary to Chylopericardium following orthotopic heart transplantation – a case report. Ann Thorac Cardiovasc Surg 22:264–266
Wong RC et al (2008) Tricuspid regurgitation after cardiac transplantation: an old problem revisited. J Heart Lung Transplant 27:247–252
Wright M et al (2017) Dose-dependent association between amiodarone and severe primary graft dysfunction in orthotopic heart transplantation. J Heart Lung Transplant 36:1226–1233
Young JB et al (2001) Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis. J Heart Lung Transplant 20:212
Zuckermann A et al (2011) Surgical wound complications after heart transplantation. Transpl Int 24:627–636
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Molina, E.J., Zhao, D. (2020). Surgical Complications. In: Bogar, L., Stempien-Otero, A. (eds) Contemporary Heart Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-33280-2_14-1
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DOI: https://doi.org/10.1007/978-3-319-33280-2_14-1
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