Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant

Minoru Ono, Randall K. Wolf, Dimitrios C. Angouras, David A. Brown, Andrew H. Goldstein, Robert E. Michler

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives: Cardiac disease is a common cause of mortality and morbidity in patients with abdominal solid organ transplant. Improvement of the results of abdominal organ transplantation has contributed to an increasing pool of patients who require open heart surgery. We investigated short- and long-term results of open heart surgery in patients with functioning abdominal solid organ transplants. Methods: We retrospectively examined 60 patients (52.5 years in average) undergoing coronary artery bypass grafting and/or valve surgery since July 1988 after abdominal organ transplantation. There were 22 females (37%). They consisted of 46 kidney, nine kidney-pancreas and five liver recipients. Cardiac surgery was performed 68.9 months after transplantation. Preoperative serum creatinine level was 2.1 mg/dl, and 11 patients (18%) had creatinine level more than 3.0 mg/dl. Eleven patients (18%) were operated upon on non-elective basis. Twelve patients (20%) were not given stress-dose steroids postoperatively. Results: Three patients died early after surgery (5.0%). Twenty-six major complications were seen in 17 patients (28%), including deterioration of renal function in seven (three patients required temporary hemodialysis), three major infections, two bleeding complications, and two strokes. No graft loss was encountered. No differences were seen in mortality and morbidity between patients with or without stress-dose steroids. Multivariate analysis identified cardiopulmonary bypass time (P < 0.05) as a risk factor for operative death, preoperative creatinine level (P < 0.05), cardiopulmonary bypass time (P < 0.05) and the amount of fresh frozen plasma used (P < 0.05) for major complication, non-elective surgery (P < 0.01) for deterioration of renal function. Thirteen patients died and five kidney allografts failed late after surgery. Three- and 5-year patient and graft survivals were 70.8 and 66.8, 84.5 and 84.5%, respectively. Multivariate regression analysis identified female gender (P < 0.05), body mass index (P < 0.001) and non-elective surgery (P < 0.001) as risk factors for late death, and preoperative creatinine level (P < 0.05) for late graft loss. Conclusions: Open heart surgery can be performed with acceptable short- and long-term results in patients with functioning abdominal transplants. Stress-dose steroid may be unnecessary in selected patients. Aggressive use of open heart surgery in this patient population to avoid non-elective surgery may further improve early and late surgical outcomes.

Original languageEnglish (US)
Pages (from-to)1061-1072
Number of pages12
JournalEuropean Journal of Cardio-thoracic Surgery
Volume21
Issue number6
DOIs
StatePublished - 2002
Externally publishedYes

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Thoracic Surgery
Transplants
Creatinine
Kidney
Steroids
Organ Transplantation
Cardiopulmonary Bypass
Multivariate Analysis
Morbidity
Mortality
Graft Survival
Coronary Artery Bypass
Allografts
Renal Dialysis
Pancreas
Heart Diseases
Body Mass Index
Transplantation
Stroke
Regression Analysis

Keywords

  • Coronary artery bypass grafting
  • Liver transplantation
  • Open heart surgery
  • Pancreas transplantation
  • Renal transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant. / Ono, Minoru; Wolf, Randall K.; Angouras, Dimitrios C.; Brown, David A.; Goldstein, Andrew H.; Michler, Robert E.

In: European Journal of Cardio-thoracic Surgery, Vol. 21, No. 6, 2002, p. 1061-1072.

Research output: Contribution to journalArticle

Ono, Minoru ; Wolf, Randall K. ; Angouras, Dimitrios C. ; Brown, David A. ; Goldstein, Andrew H. ; Michler, Robert E. / Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant. In: European Journal of Cardio-thoracic Surgery. 2002 ; Vol. 21, No. 6. pp. 1061-1072.
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AU - Ono, Minoru

AU - Wolf, Randall K.

AU - Angouras, Dimitrios C.

AU - Brown, David A.

AU - Goldstein, Andrew H.

AU - Michler, Robert E.

PY - 2002

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N2 - Objectives: Cardiac disease is a common cause of mortality and morbidity in patients with abdominal solid organ transplant. Improvement of the results of abdominal organ transplantation has contributed to an increasing pool of patients who require open heart surgery. We investigated short- and long-term results of open heart surgery in patients with functioning abdominal solid organ transplants. Methods: We retrospectively examined 60 patients (52.5 years in average) undergoing coronary artery bypass grafting and/or valve surgery since July 1988 after abdominal organ transplantation. There were 22 females (37%). They consisted of 46 kidney, nine kidney-pancreas and five liver recipients. Cardiac surgery was performed 68.9 months after transplantation. Preoperative serum creatinine level was 2.1 mg/dl, and 11 patients (18%) had creatinine level more than 3.0 mg/dl. Eleven patients (18%) were operated upon on non-elective basis. Twelve patients (20%) were not given stress-dose steroids postoperatively. Results: Three patients died early after surgery (5.0%). Twenty-six major complications were seen in 17 patients (28%), including deterioration of renal function in seven (three patients required temporary hemodialysis), three major infections, two bleeding complications, and two strokes. No graft loss was encountered. No differences were seen in mortality and morbidity between patients with or without stress-dose steroids. Multivariate analysis identified cardiopulmonary bypass time (P < 0.05) as a risk factor for operative death, preoperative creatinine level (P < 0.05), cardiopulmonary bypass time (P < 0.05) and the amount of fresh frozen plasma used (P < 0.05) for major complication, non-elective surgery (P < 0.01) for deterioration of renal function. Thirteen patients died and five kidney allografts failed late after surgery. Three- and 5-year patient and graft survivals were 70.8 and 66.8, 84.5 and 84.5%, respectively. Multivariate regression analysis identified female gender (P < 0.05), body mass index (P < 0.001) and non-elective surgery (P < 0.001) as risk factors for late death, and preoperative creatinine level (P < 0.05) for late graft loss. Conclusions: Open heart surgery can be performed with acceptable short- and long-term results in patients with functioning abdominal transplants. Stress-dose steroid may be unnecessary in selected patients. Aggressive use of open heart surgery in this patient population to avoid non-elective surgery may further improve early and late surgical outcomes.

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KW - Coronary artery bypass grafting

KW - Liver transplantation

KW - Open heart surgery

KW - Pancreas transplantation

KW - Renal transplantation

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