THE INCIDENCE, MORBIDITY, AND MORTALITY OF SURGICAL-PROCEDURES AFTER ORTHOTOPIC HEART-TRANSPLANTATION

Objective The authors present their experience with patients having un dergone orthotopic heart transplantation (OHT) in whom surgical condit ions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported. Summary Background Data Several studies have evaluated the management options of biliary tract disease after OHT. Multiple reports of patien ts having undergone OHT who subsequently underwent peripheral vascular reconstructions, plastic reconstructive, and thoracic procedures also have been published. Methods A chart review of 349 patients who under went OHT between 1985 and 1996 was conducted to identify surgical proc edures that were required in the post-transplant period. Their outcome s are reported. Results Of 349 patients who underwent OHT, conditions requiring 94 surgical procedures developed in 54 patients (15%). Bilia ry tract disease developed in 17 patients (5%) who required cholecyste ctomy; 2 of the 5 patients with acute cholecystitis died, Eight patien ts (2%) underwent orthopedic procedures with no operative mortality. F lap advancements for sternal wound infections were performed in five p atients and four deaths occurred, Seventeen thoracic procedures were p erformed in 11 patients with an overall mortality oi 45%. Twenty-one v ascular procedures were performed on 17 patients with 1 delayed death due to a malignancy. Seven patients underwent procedures of the colon and rectum with no mortality. Seven patients underwent repair of ingui nal or incisional hernias with no mortality. Various infections occurr ed with one resultant death after operative intervention, Six procedur es were performed for diseases of the small intestine with no resultan t Conclusions Patients having undergone OHT and chronic immunosuppress ion are at increased risk of having complications develop from infecti on. Acute cholecystitis and sternal wound infection caused an inordina te risk of complications and death. Malignancies developed in four pat ients who required surgical intervention. A heightened awareness of co existing peripheral vascular disease in patients transplanted for isch emic cardiomyopathy should exist. Close screening before surgery and s urveillance after surgery to identify risk factors for infection and v ascular disease and to screen for malignancies are essential.