Acute Compartment Syndrome Following Heart Transplant

Purpose Acute compartment syndrome (ACS) is a rare limb-threatening complication following cardiac transplantation that could negatively impact on post-op rehabilitation. Methods A retrospective chart review was performed for heart transplantation at our institution between 2009-2019. Clinical characteristics of ACS were identified. Results 5 cases of lower limb ACS were observed out of 144 cardiac transplant patients (3.47%). Patients age ranged between 18 and 65, all males. Two had complex congenital heart disease, 1 ischaemic cardiomyopathy and 2 dilated cardiomyopathies. None of them had diabetes. ACS was diagnosed between 1 and 84 hours postoperatively. Doppler ultrasound of the lower limb arteries showed significant stenosis in proximal arteries in two of them and small caliber arteries in the other two. ACS occurred on the side of arteriovenous femoral cannulation. All patients had prior history of arteriovenous femoral cannulation for cardiopulmonary bypass to the same vessel. Cardiopulmonary bypass time and cross clamp time were between 245-330 minutes (mean:283.7 minutes) and 49-125 minutes (mean: 173.2 minutes) respectively. Interestingly, mean cross clamp time was 31.5 minutes shorter in patients with ACS, compared to those without ACS. All patients had factors leading to prolonged surgery including difficulty in establishing hemostasis, previous adhesions and post-op RV dysfunction. 3 patients received temporary mechanical circulatory support immediately post-transplant, including Intra Aortic Balloon Pump or Venoarterial Extracorporeal Membrane Oxygenation. Posterior compartment was the most common compartment involved. All but one underwent fasciotomy. On average ACS increased the hospital length of stay by 16 days. Functional capacity was significantly impaired at 3 months after the diagnosis with variable improvement at 6 months. ACS resulted in permanent disability in 3 patients. Conclusion ACS is a rare complication post heart transplantation with prolonged hospital stay and long-term debilitation. High index of suspicion in high risk patients, early diagnosis and timely treatment with fasciotomy could prevent from subsequent disability and limb loss.