Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Complications in Heart Transplant Recipients - A Single Center Experience -

심장이식후에 발생한 외과적 합병증 - 단일 센터 경험 -

  • Park, Kook-Yang (Department of Cardiothoracic Surgery, Gil Heart Center, Gachon University Gil Medical Center) ;
  • Park, Chul-Hyun (Department of Cardiothoracic Surgery, Gil Heart Center, Gachon University Gil Medical Center) ;
  • Jeon, Yang-Bin (Department of Cardiothoracic Surgery, Gil Heart Center, Gachon University Gil Medical Center) ;
  • Choi, Chang-Hyu (Department of Cardiothoracic Surgery, Gil Heart Center, Gachon University Gil Medical Center) ;
  • Lee, Jae-Ik (Department of Cardiothoracic Surgery, Gil Heart Center, Gachon University Gil Medical Center)
  • 박국양 (가천의과학대학교 길병원 심장센터 흉부외과) ;
  • 박철현 (가천의과학대학교 길병원 심장센터 흉부외과) ;
  • 전양빈 (가천의과학대학교 길병원 심장센터 흉부외과) ;
  • 최창휴 (가천의과학대학교 길병원 심장센터 흉부외과) ;
  • 이재익 (가천의과학대학교 길병원 심장센터 흉부외과)
  • Published : 2009.12.05
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Abstract

Background: As the patients who undergo heart transplantation have achieved better survival in recent years, growing number of recipients are at a risk for experiencing surgical complications in addition to rejection and infection. In this paper, we report on our experience with the surgical complications that occurred in heart transplant recipients. Material and Method: From April 1994 to September 2003, 37 heart transplantations were performed at our center by a single surgeon. The indications for transplantation were dilated cardiomyopathy, ischemic cardiomyopathy, valvular cardiomyopathy and familial hypertrophic cardiomyopathy. Result: Twenty postoperative complications required surgeries in 15 patients (41%). The types of operations required were; redo-sternotomy for bleeding (5), pericardiostomy for effusion (4), implantation of a permanent pacemaker (1), right lower lobe lobectomy for aspergilloma (1), removal of urinary stone (1), cholecystectomy for gall bladder stone (1), drainage of a perianal abscess (1), paranasal sinus drainage (1), total hip replacement (1), partial gingivectomy due to gingival hypertrophy (1), urethrostomy (1), herniated intervertebral disc operation (1) and total hysterectomy for myoma uteri (1). The locations of the complications were mediastinal in 10 (27%) cases and extramediastihalin 10 (27%) cases. Conclusion: The relatively high incidence of extrathoracic complications associated with heart transplantation emphasizes the importance of a multidisciplinary approach to the improve long-term survival when managing those complex patients.

배경: 심장이식이 최근 증가하면서 거부반응과 감염외의 외과적합병증도 증가하고 있다. 이 논문에서는 한 외과의에 실시된 심장이식후에 발생한 외과적합병증을 보고하고자 한다. 대상 및 방법: 1994년 4월부터 2003년 9월까지 실시된 37명의 심장이식환자를 대상으로 하였으며 심장이식의 적응은 확장성 심근증, 허혈성심근증, 판막심근증, 가족력심근증 등이었다. 결과: 총 15명의 이식환자에서 20예의 합병증이 발생하였으며 실시된 외과적 수술의 종류는 출혈로 인한 재개흉(5), 심낭액저류배액술(4), 인공박동기거치술(1), 아스페르질루스증에 의한 우하엽절제술(1), 요석제거술(1), 담낭제거술(1), 직장주위절개술(1), 부비동배액술(1), 고관절치환술(1), 치주비대에 의한 치주절개술(1), 뇨도절개술(1), 추간판 탈출증수술(1), 자궁근종으로 인한 자궁적출술(1)이 있었다. 합병증의 위치는 흉곽내가 10예, 흉곽외가 10예였다. 결론: 심장이식 수술후에는 흉곽 뿐만 아니라 다른 부위장기에 많은 합병증을 가져올 수 있기 때문에 장기생존율을 높이기 위해서는 다학제간의 적극적인 치료가 매우 중요하다.

Keywords

References

  1. Law Y, Belassario A, West L, Coles J, Taylor G, Benson L. Supramitral valve obstruction from hypertrophied native atrial tissue as a complication of orthotopic heart transplantation. J Heart Lung Transplant 1997;16:922-5
  2. Oaks TE, Rayburn BK, Brown ME, Kon ND. Acquired cor triatriatum after orthotopic cardiac transplantation. Ann Thorac Surg 1995;59:751-3 https://doi.org/10.1016/0003-4975(94)00577-X
  3. Dreyfus G, Jebara VA, Couetil JP, Carpentier A. Kinking of the pulmonary artery: a treatable cause of acute right ventricular failure after heart transplantation. J Heart Transplant 1990;9:575-6
  4. Defraigne JO, Vadhat O, Lavigne JP, Demoulin JC, Limet R. Aneurysm of the ascending aorta after cardiac transplantation. Ann Thorac Surg 1992;54:983-4 https://doi.org/10.1016/0003-4975(92)90667-S
  5. Steed DL, Brown B, Reilly JJ, et al. General surgical complications in heart and heart-lung transplantation. Surgery 1985;98:739-45
  6. Kirklin JK, Holm A, Aldrete JS, White C, Bourge RC. Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention. Ann Surg 1990;211:538-41 https://doi.org/10.1097/00000658-199005000-00003
  7. Colon R, Frazier OH, Kahan BD, et al. Complications in cardiac transplant patients requiring general surgery. Surgery 1988;103:32-8
  8. Parascandola SA, Wisman CB, Burg JE, Davis PK. Extracardiac surgical complications in heart transplant recipients. J Heart Transplant 1989;8:400-6
  9. Augustine SM, Yeo CJ, Buchman TG, Achuff SC, Baumgartner WA. Gastrointestinal complications in heart and heart- lung transplant patients. J Heart Lung Transplant 1991;10: 547-56
  10. Bhatia DS, Bowen JC, Money SR, et al. The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation. Ann Surg 1997;225:686-94 https://doi.org/10.1097/00000658-199706000-00006
  11. Kwon Jl, Kim YJ, Choi KL, et al. Meningitis clue to Listeria monocytogenes following orthotopic heart transplantation. Korean Circ J 1998;28:1616-9 https://doi.org/10.4070/kcj.1998.28.9.1616
  12. Kim YH, Son H, Song MG. Cyclosporine-associated cent rat neurotoxicity after hearat transplantation -1 case report-. Korean J Thorac Cardiovasc Surg 1997;30:1136-8
  13. Lee CK, Song SY, Lee YC, et al. A case of pneumatosis cystoides intestinalis after caradiac transplantation. Korean J Gastroenterol 1996;28:732-7
  14. Park HW, Byun SW, Kim JJ, et al. A case of NK/T-cell lymphoma in a cardiac transplant recipient. Korean J Intern Med 2006;70:335-40
  15. Song MG, Seo DM, Lee JW, et al. Cardiac transplantation -1 case report-. Korean J Thorac Cardiovasc Surg 1993;26: 224-7
  16. Billingham ME, Cary NR, Hammond ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. J Heart Transplant 1990;9:587-93