Cerebrovascular Complications After Heart Transplantation

Aída Alejaldre,Joan Martí-Fàbregas,Aida Alejaldre,Joan Marti-Fabregas,Raquel Delgado-Mederos,Miguel Ángel Santos

doi:10.2174/157340310791658811

Abstract

Neurological complications in orthotopic heart transplantation represent a major cause of morbidity and mortality despite successful transplantation. The most frequent perioperative neurological complications are delirium or encephalopathy. In this period cerebrovascular complication ranges between 5-11%. After the perioperative period, the 5-year stroke risk after cardiac transplantation is 4.1%. In a retrospective study conducted with 314 patients who underwent cardiac transplantation, it was found that 20% of cerebrovascular complications occurred within the first two weeks after transplantation, while 80% occurred in the late postoperative phase. Of these, ischemic stroke is the most common subtype. In the perioperative periode, hemodynamic instability, cardiac arrest, extracorporeal circulation over 2 hours, prior history of stroke, and carotid stenosis greater than 50% have been reported to be risk factors for the occurrence of cerebrovascular complications. Perioperative cerebrovascular complications are associated with higher mortality and poor functional outcome at one year follow-up.After the perioperative period, the only factor that has been significantly associated with an increased risk of cerebrovascular complications is a history of prior stroke, either ischemic or hemorrhagic. Other associated factors include unknown atrial fibrillation, septic emboli from endocarditis, cardiac catheterization and perioperative hemodynamic shock. According to the TOAST etiologic classification, the most prevalent etiologic subtype of ischemic stroke is undetermined cause.

Highlights

In recent decades, organ transplantation is a therapeutic alternative with excellent results in quality of life and survival
A retrospective review of 314 patients who underwent cardiac transplantation showed that 20% of cerebrovascular complications occurred within the first two weeks after transplantation, while 80% occurred after this period [5]
Neurologic complications after cardiac transplantation are a major cause of morbidity

Summary

INTRODUCTION

Organ transplantation is a therapeutic alternative with excellent results in quality of life and survival. Since the first heart transplant performed by Bernard in 1967, improvement in surgical techniques as well as immunosuppression has led to increasing survival rates up to 80% in the first year, and 70% at 5 years [1]. For this reason, heart transplantation is an elective treatment for patients with advanced irreversible cardiopathies with no other feasible medical or surgical options. The most frequent perioperative neurological complications are delirium or encephalopathy (9% of transplant patients in some series) [2] Cerebrovascular complication during this period ranges between 5-11% [2, 4].

Seizures Peripheral neuropathy or myopathy

Cerebrovascular Complications

Intraoperative and Perioperative Period

Findings

CONCLUSION