Percutaneous coronary interventions in cardiac allograft vasculopathy: a single-center experience
P Colombo1, G Bruschi, A Sacco
1A De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Insights
Percutaneous coronary intervention (PCI) with stents is safe for heart transplant recipients, achieving high success rates. Drug-eluting stents may reduce restenosis compared to bare-metal stents, though disease progression remains a concern.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Background:
- Cardiac allograft vasculopathy (CAV) is accelerated obstructive coronary disease and a leading cause of late mortality post-heart transplant.
- Percutaneous coronary intervention (PCI) for CAV has historically shown high restenosis rates, often considered palliative.
Purpose of the Study:
- To review the experience with percutaneous coronary interventions (PCI) using stents in cardiac transplant recipients.
- To evaluate the safety and efficacy of PCI in managing cardiac allograft vasculopathy.
Main Methods:
- Analysis of primary adult heart transplant patients who underwent PCI after at least 12 months post-transplant.
- Inclusion criteria: hospital discharge post-transplant and clinical follow-up of 12 months.
Main Results:
- Seventy patients underwent 85 procedures treating 135 lesions; mean time to intervention was 9.3 years post-transplant.
- Primary PCI success was 96%. Recurrent stenosis occurred in 16% of patients, with 16% restenosis in drug-eluting stent (DES) treated lesions.
- Mean follow-up was 45.2 months; 27 deaths (19 cardiac) and 1 re-transplantation occurred post-PCI.
Conclusions:
- PCI with stents is a safe option for cardiac transplant recipients with high primary success rates.
- Restenosis rates after PCI in transplant recipients are higher than in native arteries.
- Drug-eluting stents may offer a benefit in reducing restenosis compared to bare-metal stents; however, overall clinical benefit may be limited by progression in untreated segments.
Objective:
Cardiac allograft vasculopathy represents an accelerated form of obstructive coronary disease. It is the main cause of late death following heart transplantation. Percutaneous coronary intervention is considered a palliative procedure due to high restenosis rates. The aim of this study was to review our experience with percutaneous coronary interventions using stents in cardiac transplant recipients.
Methods:
The present analysis included all primary adult heart transplanted patients who had been discharged from the hospital after transplantation, had a clinical follow-up of 12 months and underwent percutaneous coronary intervention (PCI).
Results:
Seventy heart transplanted patients underwent percutaneous revascularization. Our analysis comprised 85 first-vessel procedures resulting in treatment of 135 lesions. The mean time from heart transplantation to first intervention was 9.3 +/- 4.8 years. Primary success was obtained in 96% lesions; at least 1 recurrent stenosis event occurred in 16 patients with primarily successful PCI. Lesions treated with drug-eluting stents experienced recurrent stenosis in 16% of cases. During a mean follow-up after PCI of 45.2 +/- 41.7 months, 27 deaths (19 cardiac) and 1 late re-transplantation occurred after PCI.
Conclusion:
In cardiac transplant recipients, percutaneous coronary intervention with stents can be performed safely with high rates of primary success. Restenosis rates were higher compared with coronary interventions in native coronary arteries. Drug-eluting stents seemed to favorably impact restenosis compared with bare-metal stents. The clinical benefit from percutaneous coronary intervention may be reduced due to disease progression in untreated coronary segments.
