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Long-term Outcomes of Endovascular Aortic Aneurysm Repair in Cardiac Transplant Patients
Seth J. Concors, MD, Julia D. Glaser, MD, Jon G. Quatromoni, MD, Grace J. Wang, MD, Scott M. Damrauer, MD, Benjamin M. Jackson, MD, Ronald M. Fairman, MD, Paul J. Foley, III, MD.
University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVES:
To describe a single institution experience in endovascular repair of aortic aneurysms (EVAR) in cardiac transplant patients.
METHODS:
Data from all patients undergoing EVAR with a documented history of cardiac transplantation at a tertiary academic medical center between 2005 and 2014 were collected retrospectively, including demographics, size of aneurysm, type of device used, pre- and post-operative organ function, and outcomes.
RESULTS:
Out of 1382 EVARs performed in the study period, 6 (0.43%) were performed in patients with a history of cardiac transplantation. Five of the 6 patients obtained cardiac transplant for ischemic cardiomyopathy, and one patient received cardiac and bilateral lung transplant as a consequence of congenital cardiomyopathy with pulmonary hypertension. EVAR occurred an average of 10.4 years after heart transplant (range between 3.1 and 16.8 years). Of these 6 patients, the indication for EVAR was enlarging aneurysm during surveillance in 4 patients, and rupture/impending rupture in 2 patients. One patient required re-operation 6 days after EVAR for repair of bleeding from a superficial bleeding artery.
The mean follow up was 29.5 months. During the study period there were 2 deaths, and 1 patient was lost to follow up. There were no observed declines in immediate (30 days to 1 year) renal function or cardiac ejection fraction within the first postoperative year. No patients had groin wound infections, delayed wound healing, or endoleak either immediately post-op or in a delayed fashion. Average length of stay was 6.8 days, and one patient had a readmission within 30 days for complication related to previous lower extremity arterial bypass. Two deaths occurred in the study group. One patient presented with a large thalamic hemorrhagic stroke 4.8 years after EVAR likely secondary to a supertheraputic INR (on Warfarin for DVT). The second patient was found deceased 1.9 years after EVAR due to unknown circumstances; he had been in good health, with collapsed aneurism sac, when seen in the office 6 months prior.
CONCLUSIONS:
In this case series, the largest ever described for EVAR after cardiac transplant, we demonstrate that EVAR can be successfully performed with favorable long-term outcomes. Renal and cardiac function are not adversely affected by EVAR.
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