Cerebrovascular Disease as a Complication of Cardiac Transplantation

Vol. 19, No. 4, 2005

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Original Paper

Cerebrovascular Disease as a Complication of Cardiac Transplantation
Robert Belvís^a, Joan Martí-Fàbregas^a, Dolores Cocho^a, María Dolores García-Bargo^a, Elisabeth Franquet^a, Rolando Agudo^a, Vicenç Brosa^b, Marta Campreciós^b, Mireia Puig^b, Josep Lluis Martí-Vilalta^a

^aStroke Unit of the Department of Neurology, and
^bCardiac Transplantation Unit of the Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

Address of Corresponding Author

Cerebrovasc Dis 2005;19:267-271 (DOI: 10.1159/000084091)

Key Words

Cardiac transplantation
Cerebral infarction

Abstract

Background and Objectives: To characterize the frequency, risk factors, clinical presentation and etiological subtypes of cerebrovascular diseases (CVD) following cardiac transplantation (CTX). Methods: In a retrospective review of our CTX database (period 1984-2002), we assessed demographic data, vascular risk factors, surgery and donor details. We classified ischemic stroke (IS) using the clinical criteria of the Oxfordshire Community Stroke Project and the etiological criteria of the TOAST study. Logistic regression analysis and survival curves were carried out. Results: CTX was performed in a total of 314 patients (age 46 ± 14 years, 78% male) and mean follow-up was 54 ± 57 months. Twenty-two patients (7%) presented CVD: hemorrhagic stroke in 12%, transient ischemic attack in 28% and IS in 60%. CVD were early postoperative (less than 2 weeks) in 20% of patients and late in 80%. The clinical presentation in patients with IS was total anterior circulation (23.1%), partial anterior (38.4%), lacunar (15.4%) and posterior circulation (23.1%), and the etiological classification was large artery atherosclerosis (15.4%), cardioembolism (14.4%), small vessel disease (15.4%), unusual causes (15.4%) and undetermined cause (38.4%). The only independent predictor of CVD was a prior CVD event with an odds ratio of 8.2 (95% CI, 2.2-30.2, p < 0.02). The estimated risk of CVD at 5 years was greater (p < 0.02) in patients with prior CVD (4.1%) than in those without (1.1%). Conclusions: CVD are a relatively frequent complication after CTX (7%) and usually occur in the late postoperative phase. CVD prior to transplantation increase the risk of CVD after this procedure.

Author Contacts

Dr. Robert Belvís
Stroke Unit of the Department of Neurology
Hospital de la Santa Creu i Sant Pau, Avda. Sant Antoni M. Claret 167
ES-08025 Barcelona (Spain)
Tel. +34 93 2919049, Fax +34 93 2919275, E-Mail rbelvis@hsp.santpau.es

Article Information

Received: July 28, 2004
Accepted: November 24, 2004
Published online: February 22, 2005
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 2, Number of References : 27

Medline Abstract (ID 15731558)

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