Concurrent coronary grafting of the donor heart with left internal mammary artery: 10-year experience

Area of Science:

• Cardiology
• Transplant Surgery
• Vascular Biology

Background:

• Coronary artery atherosclerosis in donor hearts can lead to organ rejection.
• Donor heart evaluation typically relies on angiography, which may not always be available.
• Palpable atherosclerosis on the left anterior descending coronary artery (LAD) is a significant concern.

Purpose of the Study:

• To evaluate the feasibility and outcomes of transplanting donor hearts with significant LAD atherosclerosis.
• To assess the efficacy of using a left internal mammary artery (LIMA) bypass for atherosclerotic lesions in donor hearts.
• To report the long-term follow-up of patients receiving these utilized organs.

Main Methods:

• Identification of four donor hearts with palpable LAD atherosclerosis.
• Utilization of donor coronary angiography and bench angiography to assess lesion significance.
• Surgical implantation of donor hearts with LIMA bypass grafting around significant atherosclerotic lesions.
• Long-term clinical outcome monitoring and follow-up.

Main Results:

• Four donor hearts, initially deemed high-risk due to LAD atherosclerosis, were successfully transplanted.
• LIMA bypass effectively circumvented significant atherosclerotic lesions in the donor coronary arteries.
• No immediate post-transplant complications directly attributed to the pre-existing atherosclerosis were reported.
• Favorable long-term outcomes and patient survival were observed in the follow-up period.

Conclusions:

• Donor hearts with significant coronary artery atherosclerosis can be safely utilized for transplantation.
• Left internal mammary artery bypass grafting is a viable strategy to manage significant atherosclerotic lesions in donor LAD.
• This approach expands the donor pool and improves organ utilization in heart transplantation.