HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mario Viganó Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Viganó, M. Articles by Grande, A. M. Search for Related Content PubMed PubMed Citation Articles by Viganó, M. Articles by Grande, A. M.

Ann Thorac Surg 1999;68:105-111
© 1999 The Society of Thoracic Surgeons

---

Original Articles

The spectrum of aortic complications after heart transplantation

^a Division of Cardiac Surgery "Ch. Dubost" Center, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy

Address reprint requests to Dr Rinaldi, Division of Cardiac Surgery, IRCCS Policlinico S. Matteo, Piazza Golgi 4, 27100 Pavia, Italy
e-mail: m.rinaldi{at}smatteo.pv.it

Background. The connection between the donor and the recipient aorta is a potential source of early and late complications as a result of infection, compliance mismatch, and technical and hemodynamic factors. Moreover, the abrupt change in systolic pressure after heart transplantation involves the entire thoracic aorta in the risk of aneurysm formation. The aim of this study was to analyze the types of aortic complications encountered in our heart transplantation series and to discuss etiology, diagnostic approach, and modes of treatment.

Methods. Of the 442 patients having orthotopic heart transplantation and the 11 patients having heterotopic heart transplantation at our center, 9 (2%) sustained complications involving the thoracic aorta. These 9 patients were divided into four groups according to the aortic disease: acute aortic rupture (2 patients); infective pseudoaneurysm (3 patients); true aneurysm and dissection of native aorta (2 patients); and aortic dissection after heterotopic heart transplantation (2 patients). Surgical intervention was undertaken in 8.

Results. Five (83%) of 6 patients who underwent surgical treatment for noninfective complications survived the operation, and 4 are long-term survivors. One patient who underwent a Bentall procedure 7 years after heterotopic heart transplantation died in the perioperative period of low-output syndrome secondary to underestimated chronic rejection of the graft. One patient with pseudoaneurysm survives without surgical treatment but died several years later of cardiac arrest due to chronic rejection. Both patients operated on for evolving infective pseudoaneurysm died in the perioperative period.

Conclusions. Infective pseudoaneurysms of the aortic anastomosis are associated with a significant mortality. In noninfective complications, an aggressive surgical approach offers good long-term results. The possibility of retransplantation in spite of complex surgical repair should be considered in the late follow-up after heart transplantation, due to the increasing incidence of chronic rejection.

This article has been cited by other articles:

				C Schellemans, W Tack, and M Vanderheyden Acute type A aortic dissection in a cardiac allograft recipient: case report and review of the literature Heart, November 1, 2004; 90(11): 1256 - 1258. [Abstract] [Full Text] [PDF]

				Y. Naka, N. M. Edwards, and M. C. Oz Novel technique to repair type A acute aortic dissection in patients with a left ventricular assist device Ann. Thorac. Surg., October 1, 2001; 72(4): 1403 - 1404. [Abstract] [Full Text] [PDF]

				T. Omoto, K. Minami, T. Muramatsu, S. Kyo, and R. Korfer Pseudoaneurysm after heart transplantation with history of LVAD driveline infection Ann. Thorac. Surg., July 1, 2001; 72(1): 263 - 264. [Abstract] [Full Text] [PDF]