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Surgical revascularization for cardiac allograft vasculopathy: Is it still an option?
Jay K Bhama1, Duc Q Nguyen, Sun Scolieri
1Division of Cardiothoracic Transplantation, Heart, Lung & Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. bhamajk@upmc.edu
Insights
Surgical revascularization for cardiac allograft vasculopathy is a safe and viable option for heart transplant patients, offering good medium-term survival rates. However, ongoing monitoring is crucial due to the risk of disease progression and potential need for reintervention.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Surgery
Background:
- Cardiac allograft vasculopathy (CAV) is a significant cause of mortality following heart transplantation.
- Percutaneous revascularization is currently the primary treatment for CAV.
- This study evaluates surgical revascularization outcomes for CAV.
Purpose of the Study:
- To assess the viability and outcomes of surgical revascularization for cardiac allograft vasculopathy.
- To determine if surgical intervention remains a therapeutic option for CAV.
- To analyze safety and medium-term results of coronary artery bypass grafting in heart transplant recipients with CAV.
Main Methods:
- Retrospective analysis of 13 heart transplant recipients undergoing coronary artery bypass grafting (CABG) for CAV between 1999 and 2008.
- Evaluation of CABG performed with or without percutaneous coronary intervention.
- Analysis of surgical approaches, including off-pump procedures and repeat sternotomy.
Main Results:
- 14 CABG procedures were performed at a mean of 141 months post-transplant, with an average of 2.3 grafts per patient.
- Eight procedures were performed off-pump (5 via left thoracotomy, 3 via repeat sternotomy).
- No perioperative mortalities were observed; 3 patients died within 39 months follow-up (2 from CAV, 1 from lung cancer), with 1, 5, and 7-year survival rates of 92%, 83%, and 83% respectively.
Conclusions:
- Surgical revascularization for CAV is a safe and viable option for selected heart transplant patients, yielding good medium-term outcomes.
- Patients require continued monitoring due to the risk of CAV progression.
- The possibility of needing percutaneous or surgical reintervention exists for patients with CAV post-CABG.
Objectives:
Cardiac allograft vasculopathy remains a major cause of mortality after cardiac transplantation. Percutaneous revascularization has become the mainstay of therapy given the poor historical outcomes with surgery. Outcomes following surgical revascularization are evaluated to determine whether surgery remains a viable therapeutic option.
Methods:
A retrospective analysis was performed of 13 heart transplant recipients who had cardiac allograft vasculopathy requiring coronary artery bypass grafting with or without adjunctive percutaneous coronary intervention for revascularization from 1999 to 2008.
Results:
Thirteen patients had 14 coronary artery bypass grafting procedures at 141 +/- 66 months after transplantation. The average number of grafts was 2.3. Eight were performed without cardiopulmonary bypass, of which 5 were approached via left thoracotomy and the remainder via repeat sternotomy. One patient had renal failure and a cerebrovascular accident. Percutaneous coronary intervention before or after coronary artery bypass grafting was required in 3 patients. There were no perioperative mortalities. At mean follow-up of 39 +/- 36 months, 3 patients have died, 2 from progressive cardiac allograft vasculopathy and 1 from lung cancer. Kaplan-Meier survival for this group of patients was 92%, 83%, and 83% at 1, 5, and 7 years, respectively.
Conclusions:
Surgical revascularization for cardiac allograft vasculopathy remains a viable treatment option for appropriate patients and may be performed safely with good medium-term outcomes. However, patients remain at risk for disease progression and may require percutaneous or surgical reintervention.
