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[Coronary angioplasty in cardiac transplantation]
I Rashdan1, G Gosselin, M Carrier
1Département de médecine, Institut de cardiologie de Montréal, Québec, Canada.
Insights
Coronary angioplasty in heart transplant recipients showed high initial success but concerning long-term outcomes. Further trials are needed to evaluate its impact on survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Context:
- Coronary artery disease (CAD) is a significant threat to long-term survival after cardiac transplantation.
- Management strategies for CAD in transplant recipients are not well-established.
- Percutaneous transluminal coronary angioplasty (PTCA) is considered for select cases with limited lesions.
Purpose:
- To evaluate the efficacy and safety of percutaneous transluminal coronary angioplasty (PTCA) in patients following cardiac transplantation.
- To assess the procedural success and clinical outcomes of PTCA in this specific patient population.
Summary:
- A total of 10 PTCA procedures were performed on 7 heart transplant recipients between 1983 and 1994.
- Procedures were primarily performed in asymptomatic patients or those with asymptomatic angiographic abnormalities or painless ischemia.
- Primary angiographic success was achieved in 90% of lesions, with complications including acute occlusion and arteriovenous fistula. Three patients died within 10 months post-procedure.
- After a 24-month follow-up, 3 out of 7 patients remained event-free (no myocardial infarction, repeat angioplasty, re-transplantation, or death).
Impact:
- PTCA demonstrated high technical success in treating coronary artery disease in heart transplant patients.
- The long-term clinical impact and survival benefit of PTCA in this population remain uncertain.
- A multicenter prospective controlled trial is essential to determine the true effect of PTCA on graft and patient survival in cardiac transplant recipients.
Abstract:
Coronary artery disease is a common complication of cardiac transplantation threatening long-term survival and its management is not well defined. Percutaneous transluminal coronary angioplasty has been proposed as a palliative and exceptional technique in some patients with limited lesions. Of 145 patients undergoing cardiac transplantation between April 1983 and January 1994, 7 underwent 10 coronary angioplasty procedures. The majority was performed in asymptomatic patients, 4 for angigraphic abnormalities alone and 3 for documented painless ischaemia. Primary angiographic success was obtained in 90% (9 out of 10) of lesions. Complication included one acute occlusion and one arteriovenous fistula. Three patients died, 1, 8 and 10 months after angioplasty. After an average of 24 months' follow-up, 3 (out of 7) patients had no cardiac events (myocardial infarction, second angioplasty, second transplantation or death). A multicentre prospective controlled trial is necessary to assess the impact of this procedure on graft and patient survival.