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Published on: October 11, 2024
Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation
Giorgio Zanotti1, Matthew G Hartwig, Anthony W Castleberry
11 Division of General Surgery, Duke University Medical Center, Durham, NC. 2 Cardiothoracic Surgery, Duke University Medical Center, Durham, NC. 3 Cardiothoracic Surgery, University of Kentucky, Lexington, KY. 4 Duke Clinical Research Institute, Durham, NC. 5 Address correspondence to: Giorgio Zanotti, Duke University Medical Center, Duke South - White Zone, Box 3443, Durham, NC 27710.
Insights
Mild-to-moderate coronary artery disease (Mod-CAD) does not negatively impact survival after lung transplant. Close monitoring for coronary artery disease progression is recommended in transplant recipients with risk factors.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Coronary artery disease (CAD) is prevalent in lung transplant candidates.
- Historically, significant CAD has been a contraindication for lung transplantation.
- Outcomes for lung transplant recipients with mild-to-moderate CAD (Mod-CAD) are not well-established.
Purpose of the Study:
- To evaluate the impact of Mod-CAD on lung transplant outcomes.
- To compare perioperative and long-term results between lung transplant recipients with and without Mod-CAD.
Main Methods:
- Retrospective study of 539 lung transplant recipients (1996-2010) with pretransplant coronary angiography.
- Exclusion of patients who underwent prior revascularization or received multivisceral/redo/lobar transplants.
- Grouped patients into Mod-CAD (n=177) and no-coronary artery disease (No-CAD, n=362) groups.
Main Results:
- No significant difference in perioperative morbidity/mortality or overall survival between Mod-CAD and No-CAD groups.
- Mod-CAD patients experienced shorter hospitalizations (12 vs. 14 days).
- Higher rates of late coronary revascularization (PCI/CABG) were observed in the Mod-CAD group.
Conclusions:
- Mod-CAD is not associated with increased perioperative risks or reduced survival post-lung transplant.
- Coronary artery disease can progress in lung transplant recipients, potentially requiring revascularization.
- Regular screening for CAD progression is advised for lung transplant patients with risk factors to prevent cardiac morbidity.
Background:
Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined.
Methods:
All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization.
Results:
Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411).
Conclusions:
Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity.
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