Percutaneous coronary artery revascularization procedures in pediatric heart transplant recipients: A large single
Mariel E Turner1, Linda J Addonizio1, Marc E Richmond1
1Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
Insights
Percutaneous coronary interventions (PCI) are safe for pediatric heart transplant recipients with cardiac allograft vasculopathy (CAV). However, long-term outcomes remain challenging, with high rates of disease progression and graft failure.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplant Cardiology
Background:
- Cardiac allograft vasculopathy (CAV) is a primary cause of graft failure, mortality, and re-transplantation in pediatric heart transplant (HTx) recipients.
- Limited data exist on the efficacy of percutaneous coronary interventions (PCI) for CAV in pediatric patients, contrasting with adult studies showing short-term benefits but no long-term outcome improvements.
Purpose of the Study:
- To report the largest single-center experience with PCI for CAV in pediatric heart transplant recipients.
- To evaluate the safety and effectiveness of PCI in this population.
Main Methods:
- Retrospective chart review of pediatric HTx recipients who underwent PCI for CAV between 2005 and 2014.
- Analysis of procedural success, complications, and long-term graft survival outcomes.
Main Results:
- Twenty-three PCI procedures were performed in 13 pediatric patients, with a median age of 16.4 years.
- Acute procedural success was achieved in all but one case, with a single procedure-related complication.
- During follow-up, 7/13 patients required repeat PCI, two died, and five underwent re-transplantation, with 1-year freedom from death or re-transplant at 54%.
Conclusions:
- PCI can be safely and effectively performed in pediatric HTx recipients diagnosed with CAV.
- Despite procedural success, outcomes mirror adult experiences, indicating a persistent high rate of disease progression and graft failure.
Objectives:
To describe our experience, at a large pediatric heart transplant center, with percutaneous coronary interventions (PCI) for cardiac allograft vasculopathy (CAV).
Background:
CAV is a leading cause of late graft failure, mortality, and re-transplantation in pediatric heart transplant (HTx) recipients. Studies of PCI in adult patients have shown some short-term improvements, but no significant change in long-term outcomes. There are limited data on PCI for CAV in pediatric patients. We describe the largest single-center experience to date.
Methods:
We performed a retrospective chart review of all pediatric HTx recipients who underwent PCI for a diagnosis of CAV from 2005 to 2014.
Results:
Twenty-three procedures were performed in 13 patients, at a median age of 16.4 years (range 5.6-21.2) and median time from HTx to first PCI of 8.3 years (range 2.9-20.3). Three cases consisted of angioplasty alone, two cases had bare metal stents implanted, and the remaining 18 had drug-eluting stents implanted. There was acute procedural success in all but one case, and there was only one procedure-related complication (rebleeding from access site). During the follow-up interval (median 10.4 months, range 0.2-111.8), 7/13 patients had repeat PCI performed, two patients died (at 1.8 and 5.8 months post-PCI), and five were re-transplanted (range 0.2-18 months post-PCI). Freedom from death or retransplant by Kaplan-Meier analysis was 54% at 1 year.
Conclusions:
PCI can be performed safely and effectively in pediatric HTx recipients with CAV. Similar to the adult experience, there remains a high rate of disease progression and graft failure. © 2016 Wiley Periodicals, Inc.
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