title: Extramediastinal surgical problems in heart transplant recipients.
abstract: BACKGROUND
  As heart transplantation has gained wide acceptance, a growing number of recipients are at risk of experiencing extramediastinal surgical problems.
  
  
  METHODS
  We retrospectively reviewed our experience in the diagnosis and management of surgical problems occurring in 94 consecutive patients having heart transplantation. During the period of the study, we progressively adopted a policy of low-level immunosuppression, aiming toward monotherapy with cyclosporine.
  
  
  RESULTS
  Seventy-four extramediastinal surgical problems developed in 44 of 94 patients (47%). The type of problems were gastrointestinal in 17 of 74 (23%), vascular in 13 of 74 (17.5%), urogenital in 8 of 74 (11%), and neurologic in 4 of 74 (5.5%). There were also 9 of 74 cases of trauma (12%), 9 of 74 skin tumors (12%), and 14 of 74 miscellaneous diseases (19%). Sixty-two surgical diseases occurring in 40 patients required 75 surgical interventions, 11 of them (15%) on an emergency basis. Operations were performed for 12 of 74 neoplasms (16%) and 12 of 74 infectious or potentially infectious diseases (16%). Surgical diseases occurred most commonly within the first 6 months after transplantation (20 of 74; 27%). Complications occurred in 8 of 75 surgical interventions (9%). A high proportion of surgical disease was potentially related to immunosuppressive therapy (37 of 74; 50%) or to transplantation itself (7 of 74; 9%).
  
  
  CONCLUSIONS
  Extramediastinal diseases after heart transplantation involve most surgical specialties. Most of them are potentially linked with either the immunosuppressive therapy or the transplantation procedure, supporting our low-level immunosuppression policy. Expectant management is not justified in this population, who withstands operations well both early and late after transplantation.
authors.affiliation: Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: X M
authors.initials: XM
authors.lastname: Mueller
authors.forename: H T
authors.initials: HT
authors.lastname: Tevaearai
authors.forename: F
authors.initials: F
authors.lastname: Stumpe
authors.forename: M
authors.initials: M
authors.lastname: Hurni
authors.forename: P
authors.initials: P
authors.lastname: Ruchat
authors.forename: C
authors.initials: C
authors.lastname: Seydoux
authors.forename: J J
authors.initials: JJ
authors.lastname: Goy
authors.forename: L K
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000209:etiology