title: Open heart surgery after renal transplantation.
abstract: OBJECTIVE
  to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan.
  
  
  METHODS
  we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)).
  
  
  RESULTS
  5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45.
  
  
  CONCLUSIONS
  careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss.
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan yamachan@hcm-mail.hyo-med.ac.jp.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yamamura
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Mitsuno
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ryomoto
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukui
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Tsujiya
authors.affiliation: Department of Cardiovascular Surgery, Hyogo College of Medicine, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kajiyama
authors.affiliation: Department of Urology & Kidney Transplant Center, Hyogo College of Medicine, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Nojima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006331:Heart Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007564:Japan; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Coronary artery bypass grafting; Coronary disease; Heart valve diseases; Japan; Kidney transplantation