Extramediastinal surgical problems in heart transplant recipients.


Autoria(s): Mueller X.M.; Tevaearai H.T.; Stumpe F.; Hurni M.; Ruchat P.; Seydoux C.; Goy J.J.; von Segesser L.K.
Data(s)

1999

Resumo

BACKGROUND: As heart transplantation has gained wide acceptance, a growing number of recipients are at risk of experiencing extramediastinal surgical problems. STUDY DESIGN: We retrospectively reviewed our experience in the diagnosis and management of surgical problems occurring in 94 consecutive patients having heart transplantation. During the period of the study, we progressively adopted a policy of low-level immunosuppression, aiming toward monotherapy with cyclosporine. RESULTS: Seventy-four extramediastinal surgical problems developed in 44 of 94 patients (47%). The type of problems were gastrointestinal in 17 of 74 (23%), vascular in 13 of 74 (17.5%), urogenital in 8 of 74 (11%), and neurologic in 4 of 74 (5.5%). There were also 9 of 74 cases of trauma (12%), 9 of 74 skin tumors (12%), and 14 of 74 miscellaneous diseases (19%). Sixty-two surgical diseases occurring in 40 patients required 75 surgical interventions, 11 of them (15%) on an emergency basis. Operations were performed for 12 of 74 neoplasms (16%) and 12 of 74 infectious or potentially infectious diseases (16%). Surgical diseases occurred most commonly within the first 6 months after transplantation (20 of 74; 27%). Complications occurred in 8 of 75 surgical interventions (9%). A high proportion of surgical disease was potentially related to immunosuppressive therapy (37 of 74; 50%) or to transplantation itself (7 of 74; 9%). CONCLUSIONS: Extramediastinal diseases after heart transplantation involve most surgical specialties. Most of them are potentially linked with either the immunosuppressive therapy or the transplantation procedure, supporting our low-level immunosuppression policy. Expectant management is not justified in this population, who withstands operations well both early and late after transplantation.

Identificador

http://serval.unil.ch/?id=serval:BIB_4F67FC31ADF8

isbn:1072-7515

pmid:10509464

doi:10.1016/S1072-7515(99)00165-9

isiid:000082832600007

Idioma(s)

en

Fonte

Journal of the American College of Surgeons, vol. 189, no. 4, pp. 380-8

Palavras-Chave #Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Female; Gastrointestinal Diseases; Heart Transplantation; Humans; Male; Middle Aged; Myocardial Ischemia; Postoperative Complications; Retrospective Studies; Vascular Diseases
Tipo

info:eu-repo/semantics/article

article