Key result
PCI achieves ~94% angiographic success in cardiac transplant recipients with allograft vasculopathy.
Why the study?
Does coronary revascularization improve survival without retransplantation in cardiac transplant recipients with allograft coronary disease?
Cohort (n=89)
Yes
Does coronary revascularization improve survival without retransplantation in cardiac transplant recipients with allograft coronary disease?
Coronary angioplasty may serve as an effective palliative therapy with acceptable survival in cardiac transplant recipients with allograft coronary disease, provided they lack angiographic distal arteriopathy.
OBJECTIVES: This study sought to analyze the outcomes of revascularization procedures in the treatment of allograft coronary disease. BACKGROUND: Allograft vasculopathy is the main factor limiting survival of heart transplant recipients. Because no medical therapy prevents allograft atherosclerosis, and retransplantation is associated with suboptimal allograft survival, palliative coronary revascularization has been attempted. METHODS: Thirteen medical centers retrospectively analyzed their complete experience with percutaneous transluminal coronary angioplasty, directional coronary atherectomy and coronary bypass graft surgery in allograft coronary disease. RESULTS: Sixty-six patients underwent coronary angioplasty. Angiographic success (< or = 50% residual stenosis) occurred in 153 (94%) of 162 lesions. Forty patients (61%) are alive without retransplantation at 19 +/- 14 (mean +/- SD) months after angioplasty. The consequences of failed revascularization were severe. Two patients sustained periprocedural myocardial infarction and died. Angiographic restenosis occurred in 42 (55%) of 76 lesions at 8 +/- 5 months after angioplasty. Angiographic distal arteriopathy adversely affected allograft survival. Eleven patients underwent directional coronary atherectomy. Angiographic success occurred in 9 (82%) of 11 lesions. Two periprocedural deaths occurred. Nine patients are alive without transplantation at 7 +/- 4 months after atherectomy. Bypass graft surgery was performed in 12 patients. Four patients died perioperatively. Seven patients are alive without retransplantation at 9 +/- 7 months after operation. CONCLUSIONS: Coronary revascularization may be an effective palliative therapy in suitable cardiac transplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underwent atherectomy and coronary bypass surgery, assessment of these procedures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization.
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Halle et al. (1995) conducted a cohort in Allograft coronary disease (n=89). Coronary revascularization (angioplasty, atherectomy, bypass surgery) was evaluated on Angiographic success and survival without retransplantation. Coronary angioplasty in cardiac transplant recipients with allograft coronary disease achieved 94% angiographic success per lesion, with 61% of patients alive without retransplantation at 19 months.
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