CARDIAC OPERATIONS IN SOLID-ORGAN TRANSPLANT RECIPIENTS

Background. The success of solid organ transplantation has resulted in an increasing pool of patients that subsequently require cardiac surg ical procedures, yet the perioperative management of these patients is not well documented. We report a single institutional experience with the management techniques used and the outcomes of the cardiac surgic al procedures performed in solid organ transplant recipients with func tioning allografts. Methods. Sixty-four patients underwent 66 cardiac procedures broken down as follows: coronary artery bypass grafting, 30 ; single or combined valve replacement-repair, 24; combined coronary a rtery bypass grafting and valve repair, 3; aortic repair, 4; pericardi ectomy, 3; transmyocardial laser revascularization, 1; and native card iectomy, 1. Patients consisted of 40 kidney, 16 liver, 5 heart, 2 lung , and 1 liver and kidney transplant recipients. The mean interval from the time of transplantion to the cardiac operation was 53 months (ran ge, 1 day to 220 months). Forty-six male and 18 female patients in New York Heart Association functional class III or IV had a mean age of 5 3 years (range, 19 to 77 years); 50% (32/64) were diabetic, and 97% (6 2/64) were hypertensive. Immunosuppressive therapy, cardiopulmonary by pass, and medical management were similar in all patients. Results; Th ere were two (3%) perioperative deaths, one of which was caused by an arrhythmia-induced cardiac arrest, and there were seven (11%) late dea ths from non-cardiac-related causes, Major complications included 12 i nfections (19%), ten mediastinal reexplorations for the control of ble eding (16%), and nine others (15%). Sixteen of the 64 (25%) transplant recipients had chronic renal failure (serum creatinine levels, >3 mg/ dL), including 13 of 40 (33%) kidney transplant patients. Acute renal failure developed postoperatively in 7 (54%) of these 13 patients; the grafts failed permanently in 3 (23%). Three patients (5%), 2 kidney t ransplant recipients and I lung transplant recipient, experienced tran sient acute rejection. Fifty of the 55 surviving patients are alive an d well (New York Heart Association functional class I or II) without r ecurrent cardiac disease at a mean follow-up period of 22 months. Conc lusions. Although the short-term morbidity was significant, the low mo rtality and low incidence of permanent graft dysfunction indicate that solid organ transplant recipients fan safely and effectively undergo subsequent cardiac surgical procedures. (C) 1997 by The Society of Tho racic Surgeons.