title: Cardiac surgery late after heart transplantation: a safe and effective treatment option.
abstract: OBJECTIVE
  Owing to the improved long-term outcome after cardiac transplantation, cardiac allograft vasculopathy or valvular disease is developing late after heart transplantation in a growing number of patients. In this study, we evaluated our results of nonretransplant cardiac surgery in these patients and compared them with those after retransplantation.
  
  
  METHODS
  Since 1983, a total of 867 heart transplantations have been performed at our institution. Among them, 44 patients underwent nonretransplant cardiac surgery, 4 of them repeatedly. The procedures included 19 coronary artery revascularizations, 20 tricuspid valve procedures, 4 other valvular procedures, 4 aortic operations, and 1 right atrial thrombectomy. Long-term results of these patients were compared with those of 20 patients after late cardiac retransplantation.
  
  
  RESULTS
  Indications for nonretransplant surgery included cardiac allograft vasculopathy, tricuspid regurgitation, aortic and mitral valve insufficiency, as well as acute aortic dissection type A. Mean interval between heart transplantation and reoperation was 8.4 years. Mean follow-up was 5.8 years. Early mortality was 4.5% (2/44). The early deaths were caused by intracerebral bleeding and acute rejection. Actuarial survivals at 1, 5, and 7 years were 84%, 64%, and 58%, respectively. In comparison, early mortality in the retransplant group was 20% (4/20) and survivals at the same time points were 70%, 70%, and 47%, respectively.
  
  
  CONCLUSIONS
  According to these results, we consider nonretransplant surgical options for cardiac allograft vasculopathy and valvular disease a safe and effective therapeutic approach with low early mortality and acceptable long-term results.
authors.affiliation: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. goerler.adelheid@mh-hannover.de
authors.forename: Heidi
authors.initials: H
authors.lastname: Goerler
authors.forename: Andre
authors.initials: A
authors.lastname: Simon
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Anna L
authors.initials: AL
authors.lastname: Meyer
authors.forename: Christian
authors.initials: C
authors.lastname: Kuehn
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents