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Ann Thorac Surg 2007;83:1684-1690
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Significance of Neurologic Complications in the Modern Era of Cardiac Transplantation

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
^b Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri

Accepted for publication December 11, 2006.

^_* Address correspondence to Dr Moazami, Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8234, St. Louis, MO62236 (Email: moazamin{at}wustl.edu).

Background: Severe neurologic complications after cardiac transplantation are devastating outcomes of this life-saving procedure. Incidence, risk factors, and morbidity of neurologic events in the modern era of cardiac transplantation are yet to be defined.

Methods: Between 1996 and 2005, 200 patients (64% men; mean age, 49 ± 12 years) underwent heart transplantation at our institution. Overall, 46 patients (23%) showed a wide spectra of early neurologic complications.

Results: Cause of ischemic complications was stroke in 11 patients (7 had concomitant epileptic seizures) and transient ischemic attack (TIA) in 7. Encephalopathy (n = 10), epileptic seizures unrelated to focal cerebral lesions (n = 7), severe headache (n = 6), cerebral infection (n = 3), and peripheral nervous system injuries (n = 2) completed the spectra of adverse neurologic outcomes. Multivariate analysis identified advanced age (p = 0.03), preoperative left ventricular assist device support (p = 0.02), preoperative intraaortic balloon pump support (p < 0.001), prolonged cardiopulmonary bypass time (p < 0.001), and postoperative hepatic failure (p = 0.04) as independent predictors of early neurologic complications. Postoperative morbidities associated with neurologic complications included longer ventilation time (p < 0.001), longer stay in the intensive care unit (p < 0.001), and higher incidence of pneumonia (p < 0.001) and sepsis (p = 0.01) compared with patients without neurologic events. There was a trend toward higher in-hospital mortality (15% versus 6%, p = 0.07), but there was no difference in long-term survival (65% versus 78%, p = 0.15).

Conclusions: Despite rigorous pretransplantation screening, neurologic complications were common after cardiac transplantation. Most frequently, these complications were not the actual cause of death, but they significantly contributed to increased morbidity. Preoperative mechanical circulatory support requirement was the strongest predictor for adverse neurologic outcome.

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Invited commentary

Igor Knez and Bruno Rigler
Ann. Thorac. Surg. 2007 83: 1690. [Extract] [Full Text] [PDF]

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