Between 1984 and 1989, orthotopic
cardiac transplantations were done in 90 patients from 10 to 65 years of age for end-stage, refractory
congestive cardiomyopathy. Two patients had had
ischemic strokes 5 months and 18 years, respectively, before
transplantation. Six patients (7%) suffered acute neurologic events perioperatively. Three patients suffered
cerebral infarctions. In 1 case this occurred 10 days before
transplantation--probably as a result of systemic hypoperfusion--with the placement of
ventricular assist devices. Two others suffered
infarctions 5 and 21 days, respectively, after
transplantation, each of probable embolic origin. Two patients had an acute
intracerebral hemorrhage 21 and 36 days, respectively, after
transplantation; both were located within the basal ganglia and subcortical regions. Both patients had moderate to severe
hypertension, and in 1,
renal failure and a coagulopathy developed before
hemorrhage.
Tremor,
seizures, and an
altered level of consciousness developed in 1 patient as an apparent toxic reaction to
cyclosporine treatment. Only 1 patient died as a result of the neurologic complication--of an acute
intracerebral hemorrhage. Three patients recovered fully, 2 partially. Only the case of
drug toxicity could be directly attributed to the
transplantation procedure itself. We conclude that the risk of an acute neurologic insult with orthotopic
cardiac transplantation is low but may result from
drug toxicity,
cerebral ischemia, or hemorrhagic mechanisms.