Cardiac surgery late after heart transplantation: a safe and effective treatment option.

Owing to the improved long-term outcome after cardiac transplantation, cardiac allograft vasculopathy or valvular disease is developing late after heart transplantation in a growing number of patients. In this study, we evaluated our results of nonretransplant cardiac surgery in these patients and compared them with those after retransplantation. Since 1983, a total of 867 heart transplantations have been performed at our institution. Among them, 44 patients underwent nonretransplant cardiac surgery, 4 of them repeatedly. The procedures included 19 coronary artery revascularizations, 20 tricuspid valve procedures, 4 other valvular procedures, 4 aortic operations, and 1 right atrial thrombectomy. Long-term results of these patients were compared with those of 20 patients after late cardiac retransplantation. Indications for nonretransplant surgery included cardiac allograft vasculopathy, tricuspid regurgitation, aortic and mitral valve insufficiency, as well as acute aortic dissection type A. Mean interval between heart transplantation and reoperation was 8.4 years. Mean follow-up was 5.8 years. Early mortality was 4.5% (2/44). The early deaths were caused by intracerebral bleeding and acute rejection. Actuarial survivals at 1, 5, and 7 years were 84%, 64%, and 58%, respectively. In comparison, early mortality in the retransplant group was 20% (4/20) and survivals at the same time points were 70%, 70%, and 47%, respectively. According to these results, we consider nonretransplant surgical options for cardiac allograft vasculopathy and valvular disease a safe and effective therapeutic approach with low early mortality and acceptable long-term results.

Goerler H ，Simon A ，Warnecke G ，Meyer AL ，Kuehn C ，Haverich A ，Strueber M ... -  《-》

Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience.

Goerler H ，Simon A ，Gohrbandt B ，Hagl C ，Oppelt P ，Haverich A ，Strueber M ... -  《-》

Cardiac surgery after heart transplantation: coronary artery bypass grafting and heart valve replacement.

Coskun KO ，Coskun ST ，El Arousy M ，Amin Parsa M ，Schulz U ，Deyerling W ，Tenderich G ，Bairaktaris A ，Koerfer R ... -  《-》

Nonelective cardiac surgery in the elderly: is it justified?

Elderly patients might be denied nonelective cardiac surgery because of the perception of poor outcomes and an unacceptable quality of life. In this study we evaluate long-term survival and quality of life in these patients. From 1994 to 1999, 262 consecutive patients older than 80 years underwent urgent (n = 223) or emergent (n = 39) cardiac surgery. Of these patients, 160 (61%) underwent coronary artery bypass grafting, 64 (24%) underwent coronary artery bypass grafting plus valve surgery, 17 (7%) underwent valve surgery, and 21 (8%) underwent aortic surgery. Kaplan-Meier survival analysis and quality-of-life assessment were performed, and result were compared with age-adjusted population data. Risk factors for mortality were determined by using Cox regression. The utility of Society of Thoracic Surgeons and EuroSCORE risk scoring were assessed by using area under receiver operating curves. Early mortality was 11% (n = 29) overall, 7% (n = 16) in urgent cases, and 33% (n = 13) in emergent cases. Five-year survival was 50% (n = 132) overall, 53% (n = 105) in urgent cases, and 36% (n = 18) in emergent cases. There was no difference in 10-year survival between patients undergoing urgent surgical intervention and age-adjusted population data. Among survivors, quality-of-life measures were equivalent to those of the general elderly population. Risk factors for early mortality were age, emergent procedure, aortic procedure, bypass time, and postoperative complication (renal failure, myocardial infarction, cerebrovascular accident, pneumonia, and reoperation for bleeding). Risk factors for late mortality were peripheral vascular disease, emergent procedure, bypass time, and new renal failure. The EuroSCORE and Society of Thoracic Surgeons risk scores were equivalent but only moderately predictive of mortality. Long-term survival and quality of life after nonelective cardiac surgery can equal that of the general elderly population. Age alone should not disqualify a patient for urgent or emergent cardiac surgery.

Ghanta RK ，Shekar PS ，McGurk S ，Rosborough DM ，Aranki SF ... -  《-》

Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.

Gersak B ，Sutlic Z 《HEART SURGERY FORUM》