Alvarez P, Kitai T, Okamoto T, et al. - Patients who underwent heart transplantation (HTx) infrequently developed postoperative stroke, however, postoperative stroke following HTx was linked with higher mortality. Risk factors included redo sternotomy, left ventricular assist device (LVAD), and extracorporeal membrane oxygenation (ECMO) support at HTx.

• A retrospective study of the United Network for Organ Sharing database from 2009 to 2020.

• Overall 25,015 HT recipients were examined, including 719 (2.9%) who developed a postoperative stroke.

• Rise in stroke rates, from 2.1% in 2009 to 3.7% in 2019, was evident.

• Higher risk of stroke was observed after the implantation of the new allocation system.

• Older age, higher rates of prior cerebrovascular accident (CVA), higher rates of ECMO support, LVADs, mechanical ventilation, and longer ischaemic time were found in HTx recipients with postoperative stroke.

• Independent predictors of postoperative stroke were: age, prior cardiac surgery, CVA, support with LVAD, ECMO, ischaemic time, and mechanical ventilation at the time of HTx.

• Elevated risk of 30 day and all-cause mortality (hazard ratio 1.49) was observed in relation to stroke.