BACKGROUND: Allograft vasculopathy remains a major limiting factor in long-term graft survival. The absence of symptoms and diffuse nature of the disease make clinical detection and therapy more difficult. Limited data exist on the long-term outcome of percutaneous interventions in this group of patients. METHODS: Medical records and cardiac catheterizations from the Cardiac Cath Lab database were retrospectively reviewed for all cardiac transplant recipients who had undergone a percutaneous intervention. Procedural results, complications, use of stents and angiographic follow-up were recorded. Re-stenosis was defined as a lesion >50% in the target vessel at follow-up angiography. RESULTS: Thirty-three patients underwent 97 percutaneous interventions with a mean of 2.9 interventions per patient. Mean age at the time of first intervention was 52 +/- 13 (mean +/- standard deviation) years. Mean time from transplant to first intervention was 5 +/- 3.0 years. The primary procedural success rate was 99%. Thirty-four procedures involved placement of a stent, 63 were angioplasty alone. There were no procedure-related complications. Seventy percent of lesions were de novo and 30% were re-stenotic lesions. Six-month, 12-month and 5-year target vessel re-stenosis rates in the stent group were 31%, 46% and 69%, and in the percutaneous transluminal coronary angioplasty (PTCA) group were 41%, 53% and 68%, respectively. Thirteen patients (39.3%) died or were re-transplanted, at 1.9 +/- 2.29 (mean +/- SD) years after their first intervention. Twenty patients were alive at 4.5 +/- 2.99 years after the first intervention. CONCLUSIONS: Percutaneous intervention can be performed safely in cardiac transplant recipients. Stent placement reduces early and mid-term re-stenosis, but late re-stenosis occurs in 70% of lesions. Late re-stenosis, development of new coronary lesions, and need for repeat intervention are common, regardless of the method used for percutaneous intervention, emphasizing the diffuse and progressive nature of transplant coronary disease.
BACKGROUND:Allograft vasculopathy remains a major limiting factor in long-term graft survival. The absence of symptoms and diffuse nature of the disease make clinical detection and therapy more difficult. Limited data exist on the long-term outcome of percutaneous interventions in this group of patients. METHODS: Medical records and cardiac catheterizations from the Cardiac Cath Lab database were retrospectively reviewed for all cardiac transplant recipients who had undergone a percutaneous intervention. Procedural results, complications, use of stents and angiographic follow-up were recorded. Re-stenosis was defined as a lesion >50% in the target vessel at follow-up angiography. RESULTS: Thirty-three patients underwent 97 percutaneous interventions with a mean of 2.9 interventions per patient. Mean age at the time of first intervention was 52 +/- 13 (mean +/- standard deviation) years. Mean time from transplant to first intervention was 5 +/- 3.0 years. The primary procedural success rate was 99%. Thirty-four procedures involved placement of a stent, 63 were angioplasty alone. There were no procedure-related complications. Seventy percent of lesions were de novo and 30% were re-stenotic lesions. Six-month, 12-month and 5-year target vessel re-stenosis rates in the stent group were 31%, 46% and 69%, and in the percutaneous transluminal coronary angioplasty (PTCA) group were 41%, 53% and 68%, respectively. Thirteen patients (39.3%) died or were re-transplanted, at 1.9 +/- 2.29 (mean +/- SD) years after their first intervention. Twenty patients were alive at 4.5 +/- 2.99 years after the first intervention. CONCLUSIONS: Percutaneous intervention can be performed safely in cardiac transplant recipients. Stent placement reduces early and mid-term re-stenosis, but late re-stenosis occurs in 70% of lesions. Late re-stenosis, development of new coronary lesions, and need for repeat intervention are common, regardless of the method used for percutaneous intervention, emphasizing the diffuse and progressive nature of transplant coronary disease.
Authors: Michele Pighi; Fabrizio Tomai; Alessandro Petrolini; Leonardo de Luca; Giuseppe Tarantini; Alberto Barioli; Paola Colombo; Silvio Klugmann; Marco Ferlini; Maurizio Ferrario Ormezzano; Bruno Loi; Paolo Calabrò; Renato Maria Bianchi; Giuseppe Faggian; Alberto Forni; Corrado Vassanelli; Marco Valgimigli; Flavio Ribichini Journal: J Cardiovasc Transl Res Date: 2015-12-18 Impact factor: 4.132
Authors: Joe X Xie; Jon A Kobashigawa; Kevin F Kennedy; Timothy D Henry; Steven W Tabak; Robert Krebbs; Leslee Shaw; J Dawn Abbott; Wendy Book; S Tanveer Rab; John A Spertus; Abhinav Goyal Journal: JAMA Cardiol Date: 2020-06-01 Impact factor: 14.676
Authors: Jessica G Y Luc; Jae Hwan Choi; Syed-Saif Abbas Rizvi; Kevin Phan; Ester Moncho Escrivà; Sinal Patel; Gordon R Reeves; Andrew J Boyle; John W Entwistle; Rohinton J Morris; H Todd Massey; Vakhtang Tchantchaleishvili Journal: Ann Cardiothorac Surg Date: 2018-01
Authors: Łukasz Pyka; Michał Hawranek; Bożena Szyguła-Jurkiewicz; Piotr Desperak; Wioletta Szczurek; Andrzej Lekston; Mariusz Gąsior; Michał O Zembala; Szymon Pawlak; Marian Zembala; Piotr Przybyłowski Journal: Ann Transplant Date: 2020-04-07 Impact factor: 1.530
Authors: Xiaoli Ma; Benjamin Hibbert; Dawn White; Richard Seymour; Stewart C Whitman; Edward R O'Brien Journal: PLoS One Date: 2008-03-26 Impact factor: 3.240