The spectrum of aortic complications after heart transplantation

Background. The connection between the donor and the recipient aorta is a p otential source of early and late complications as a result of infection, c ompliance mismatch, and technical and hemodynamic factors. Moreover, the ab rupt change in systolic pressure after heart transplantation involves the e ntire thoracic aorta in the risk of aneurysm formation. The aim of this stu dy was to analyze the types of aortic complications encountered in our hear t transplantation series and to discuss etiology, diagnostic approach, and modes of treatment. Methods. Of the 442 patients having orthotopic heart transplantation and th e 11 patients having heterotopic heart transplantation at our center, 9 (2% ) sustained complications involving the thoracic aorta. These 9 patients we re divided into four groups according to the aortic disease: acute aortic r upture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm a nd dissection of native aorta (2 patients); and aortic dissection after het erotopic heart transplantation (2 patients). Surgical intervention was unde rtaken in 8. Results. Five (83%) of 6 patients who underwent surgical treatment for noni nfective complications survived the operation, and 4 are long-term survivor s. One patient who underwent a Bentall procedure 7 1/2 years after heteroto pic heart transplantation died in the perioperative period of low-output sy ndrome secondary to underestimated chronic rejection of the graft. One pati ent with pseudoaneurysm survives without surgical treatment but died severa l years later of cardiac arrest due to chronic rejection. Both patients ope rated on for evolving infective pseudoaneurysm died in the perioperative pe riod. Conclusions. Infective pseudoaneurysms of the aortic anastomosis are associ ated with a significant mortality. In noninfective complications, an aggres sive surgical approach offers good long-term results. The possibility of re transplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing inci dence of chronic rejection. (C) 1999 by The Society of Thoracic Surgeons.