Related Experiment Videos
The management of post-cardiac transplantation coronary artery disease
A Parry1, M Roberts, J Parameshwar
1Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, England.
Insights
Coronary artery revascularization using percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) is feasible in select cardiac transplant patients. These interventions show promise for improving outcomes in allograft coronary artery disease.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Surgery
Background:
- Allograft coronary artery disease is a major cause of mortality after cardiac transplantation.
- This condition is aggressive and diffuse, posing significant challenges for long-term survival.
- Conventional revascularization strategies have not been extensively studied in this specific patient population.
Purpose of the Study:
- To evaluate the role and success of conventional coronary artery revascularization techniques in cardiac transplant recipients with allograft coronary artery disease.
- To assess the feasibility and outcomes of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) in this selected group.
Main Methods:
- A retrospective analysis of 557 cardiac transplant recipients between 1979 and 1993.
- Twenty patients diagnosed with allograft coronary artery disease were selected for conventional treatment.
- Percutaneous transluminal coronary angioplasty (PTCA) was performed in 18 patients, and coronary artery bypass grafting (CABG) in 5 patients.
Main Results:
- PTCA demonstrated an 84% primary success rate, with 16 out of 19 procedures being successful.
- Coronary artery bypass grafting (CABG) had a high perioperative mortality rate (2 out of 5 deaths).
- Survivors in both groups showed improved perfusion scans, with relief of angina and dyspnea.
Conclusions:
- Coronary revascularization via PTCA and CABG is a feasible option for carefully selected cardiac transplant recipients.
- While PTCA showed promising results, CABG carried significant perioperative risks in this cohort.
- Further research is needed to establish the long-term prognostic impact of revascularization on survival after cardiac transplantation.
Objective:
Allograft coronary artery disease remains the single greatest limitation to long term survival after cardiac transplantation. It is peculiarly aggressive in its behavior and diffuse in its nature. The role of conventional approaches to coronary artery revascularisation were studied in a selected group of cardiac transplant recipients.
Methods:
Of the 557 patients undergoing cardiac transplantation at our unit between January 1979 and December 1993, all were screened for the development of allograft coronary artery disease routinely after 2 years and yearly thereafter or after 4 years. Twenty patients with allograft coronary artery disease were considered suitable for treatment by conventional means 17 of whom had undergone transplantation for ischaemic cardiomyopathy and the others for dilating cardiomyopathy. Percutaneous transluminal coronary angioplasty was performed in 18, 25-103 months after transplantation (mean 60 months) all of whom had severe proximal stenoses and reversible defects on perfusion scans. None suffered chest pain. Coronary artery bypass grafting was performed in 5, 95-105 months after transplantation (mean 101 months) 2 of whom had post-infarction unstable angina and 3 had severe triple vessel disease, dyspnoea, and perfusion abnormalities.
Results:
The primary success rate for PTCA was 84% (16/19). Two lesions restenosed and 3 patients had progressive disease which necessitated coronary revascularisation. No patient died. Of the 5 patients undergoing coronary artery surgery 2 died perioperatively, one from acute left ventricular failure and one from acute rejection. All 18 survivors have improved perfusion scans. Following surgery, all survivors had improvement in dyspnoea and relief of angina. Five late deaths a mean of 89 months after transplantation were from coronary artery disease (4) and lung malignancy (1).
Conclusions:
Revascularisation by PTCA and CABG is feasible and successful in selected cardiac transplant recipients. Further study is required to determine the effect of revascularisation on prognosis.