Cardiac Surgery after Heart Transplantation: Coronary Artery Bypass Grafting and Heart Valve Replacement

Abstract

Cardiac surgical procedures can be safely performed after heart transplantation. To improve graft and patient survival, such procedures must be carefully performed after heart transplantation to avoid retransplantation. The shortage of donor organs will and must lead to an increase in the number of conventional procedures performed to improve allograft function in transplanted hearts.

Cardiac Surgery after Heart Transplantation - Elective Operation or Last Exit Strategy?

“…2,5 However, distribution of procedures (CABG vs valves vs other) was similar between the reports, with 35% to 41% CABG procedures, 36% to 50% valve procedures, and 10% to 23% other procedures. 2,5,14 Indications for surgery at our institution changed significantly over time. Before 2005, 67% were CABG and 11% were valve procedures whereas 0% was CABG and 75% were valve operations after 2005.…”

“…2,[4][5][6][7][8][9][10][11][12][13] There are only case reports on mitral and aortic valve surgery showing that it seems to be safe in selected patients. 2,5,[14][15][16][17][18][19] New treatment options for these valves with transcatheter aortic valve implantation (TAVI) or MitraClip have been described in case reports, but the benefit of these developments in the field of HTx patients needs to be proven. 3,[20][21][22][23][24][25] Concerning the treatment of CAV with coronary artery bypass grafting (CABG), there are single-center experiences and even a published recommendation that CABG can be performed in type A lesions even though it has limited efficacy in diffuse distal artery disease.…”

“…[26][27][28][29][30] When performed in selected patients, the operation seems to be safe. 2,5,14 Retransplantation remains the last therapeutic option for cardiac allograft failure due to progressive CAV. [31][32][33][34][35] Unfortunately, this therapeutic option is limited mostly because of organ shortage and associated with long waiting times.…”

Bench Replacement of Donor Aortic Valve Before Orthotopic Heart Transplantation

“…Only several institutions have reported successful experiences with bench repair of the mitral valve 3 or tricuspid valve 4 before heart transplantation and mitral or tricuspid valve replacement after heart transpantation. 5 The report of aortic valve disease is more scant. Navia et al 6 reported aortic valve repair during heart transplantation for moderate central aortic regurgitation from a donor with normal LV function.…”

Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy?

“… 2 , 4 - 13 There are only case reports on mitral and aortic valve surgery showing that it seems to be safe in selected patients. 2 , 5 , 14 - 19 New treatment options for these valves with transcatheter aortic valve implantation (TAVI) or MitraClip have been described in case reports, but the benefit of these developments in the field of HTx patients needs to be proven. 3 , 20 - 25 …”