A review of the management of abdominal aortic aneurysms in patients following cardiac transplantation.

Abstract

To describe the presentation, preoperative assessment and postoperative management of patients presenting with an infrarenal abdominal aortic aneurysm following a previous cardiac transplant. The case histories of three patients have been examined and a literature review performed. The majority of patients developing aortic aneurysms had undergone cardiac transplantation for ischaemic cardiomyopathy and thus require detailed assessment of cardiac function preoperatively to exclude accelerated coronary artery disease in the graft. Full invasive cardiac monitoring during surgery is mandatory to maintain haemodynamic stability in patients with a dennervated heart and to avoid postoperative renal failure. The higher incidence of pulmonary and wound complications are discussed, together with protocols for maintaining adequate immunosuppression. Finally, data supporting a higher prevalence and more rapid expansion of aortic aneurysms in immunosuppressed patients is considered and evidence-based recommendations made regarding aneurysm screening in these patients.