Related Experiment Videos
Clinical outcome after coronary artery revascularization and lung transplantation
Vijay S Patel1, Scott M Palmer, Robert H Messier
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Coronary artery disease (CAD) previously excluded lung transplant candidates. Revascularization in select patients with normal heart function allows successful lung transplantation with good survival rates.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplant Medicine
Background:
- Coronary artery disease (CAD) is a traditional contraindication for lung transplantation.
- This study investigates outcomes in lung transplant recipients with operable CAD and normal left ventricular function.
Purpose of the Study:
- To evaluate the clinical outcomes of lung transplant recipients with coronary artery disease who underwent revascularization.
- To determine if selected patients with CAD can undergo lung transplantation with acceptable results.
Main Methods:
- Retrospective review of medical records for lung transplant recipients with CAD.
- Analysis of demographics, coronary angiograms, revascularization procedures, and post-transplant outcomes.
Main Results:
- Eighteen patients (5%) had significant CAD; 6 underwent percutaneous transluminal coronary angioplasty/stent, and 12 had coronary artery bypass grafting combined with lung transplantation.
- All patients were discharged, with median hospital stays of 8.5 and 16 days respectively.
- One-year survival was 88% for the 18 patients who underwent revascularization and lung transplantation.
Conclusions:
- Coronary revascularization in carefully selected lung transplant candidates with favorable coronary anatomy and normal left ventricular function is associated with acceptable outcomes.
- This approach challenges traditional exclusion criteria for lung transplantation in patients with CAD.
Background:
Presence of coronary artery disease (CAD) in otherwise eligible lung transplant candidates is considered a contraindication to lung transplantation. We reviewed the clinical outcome of our experience in lung transplant recipients with operable coronary artery disease and normal left ventricular function.
Methods:
Medical records of all transplant recipients with coronary artery disease were reviewed. Data analyzed include demographics, coronary angiograms, coronary artery revascularization procedure, and clinical outcome after lung transplantation.
Results:
Between April 1992 and August 2001, 354 lung transplant procedures were performed. Eighteen patients (5%) had significant CAD (greater than 50% stenoses). Six male patients (mean age 59 years) underwent percutaneous transluminal coronary angioplasty/stent and after lung transplantation all were discharged after a median hospital stay of 8.5 days. All recipients are alive at a median follow-up time of 14.5 months after their transplant. Twelve male patients (mean age 58 years) had combined coronary artery bypass grafting and lung transplantation. All recipients were discharged after a median hospital stay of 16 days. Nine recipients are alive at a median follow-up time of 7.5 months after transplant. One-year survival by the Kaplan-Meier method is 88% for the 18 patients with coronary artery disease who underwent revascularization and lung transplantation.
Conclusions:
Despite the traditional criteria of excluding all eligible transplant candidates due to coronary artery disease, coronary revascularization in select candidates with favorable anatomy and normal left ventricular function can allow patients to undergo lung transplantation with acceptable outcomes.