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J Thorac Cardiovasc Surg 2007;133:1218-1219
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Patricia Thistlethwaite (San Diego, Calif). The strength and breadth of solid organ transplantation at the University of Minnesota have allowed for the creation of one of the largest groups of transplant patients for the study of cardiovascular disease.

With data from the United Network for Organ Sharing suggesting that kidney transplant patients survive on the average between 10 and 23 years depending on whether the organ was from a deceased or living donor and 25 years plus for an HLA identically matched donor, and with long-term survivals for kidney–pancreas transplants approaching 10 to 20 years, it is not surprising that cardiac disease is developing in these individuals over time. It is reassuring to see actual data about the safety of cardiac surgery in patients with transplant allografts.

I have the following questions. What is the effect of immunosuppression on wound healing in cardiac surgery? Were the people who had wound complications in your group receiving higher doses of prednisone or FK506? Did infection develop in any patients who were on a steroid-free protocol? Should patients be tapered down or off steroids before their cardiac operation?

Dr John. Clearly the presence of immunosuppression did not affect the incidence of mediastinal and leg wound infection or multiorgan sepsis; however, an important immunosuppressant that clearly affects wound healing is rapamycin. We do not have much experience with this agent because none . . . [Full Text of this Article]

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Perioperative outcomes of cardiac surgery in kidney and kidney–pancreas transplant recipients

Ranjit John, Katherine Lietz, Stephen Huddleston, Arthur Matas, Kenneth Liao, Sara Shumway, Lyle Joyce, and R. Morton Bolman
J. Thorac. Cardiovasc. Surg. 2007 133: 1212-1219. [Abstract] [Full Text] [PDF]