Thoracic and cardiovascular interventions after orthotopic heart transplantation.
BACKGROUND
The long-term outcome of orthotopic heart transplantation is limited by the development of cardiac allograft vasculopathy, rejection, infection, and malignancy.


METHODS
After heart transplantation, we treated patients with thoracic and cardiovascular diseases: preexisting coronary artery sclerosis in 2 patients, cardiac allograft vasculopathy in 19, valvular disease in 3, mycotic ascending aortic aneurysm in 2, superior vena cava stenosis in 2, and lung neoplasm in 10 patients.


RESULTS
We successfully performed coronary artery bypass grafting for preexisting coronary artery sclerosis, valve replacement for valvular disease, and patch enlargement for superior vena cava stenosis. Percutaneous transluminal coronary angioplasty for cardiac allograft vasculopathy achieved excellent initial results, but the incidence of restenosis was high (67%). One patient who underwent coronary artery bypass grafting for cardiac allograft vasculopathy died immediately after operation. Graft replacement was performed for mycotic aortic aneurysm, but 1 patient required reoperation because of recurrent aneurysm. The long-term survival rate in patients undergoing surgical resection for lung neoplasm was poor (50%).


CONCLUSIONS
The need for thoracic and cardiovascular interventions in patients after heart transplantation was low (4.7%). Use of the appropriate procedures can improve the long-term survival after heart transplantation.
Koyanagi
T
T
Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany.
Minami
K
K
Tenderich
G
G
Reiss
N
N
Morshius
M
M
Mirow
N
N
Körfer
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000209:etiology; D001014:Aortic Aneurysm / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D016027:Heart Transplantation; D006349:Heart Valve Diseases / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013479:Superior Vena Cava Syndrome / Q000209:etiology