Percutaneous coronary interventions in patients with transplanted heart coronary artery disease. Effects of intracoronary stent implantation on long-term results.
BACKGROUND
Transplanted heart coronary artery disease (TxCAD) is the most frequent casue of death occuring > or =5 years after orthotopic heart transplantation (OHT). Considering three basic therapeutic approaches - percutaneous coronary intervention (PCI), surgical revascularisation and retransplantation - PCI seems to be the superior method due to its safety and good short-term results, however, the long-term efficacy of PCI has been less well established.


OBJECTIVE
To evaluate long-term results of PCI in the treatment of OHT recipients with TxCAD.


METHODS
The study group consisted of 20 patients (19 males, aged 24-63, median 45.5 years; 14 (70%) had before OHT), who underwent single or multiple PCI of significant coronary lesions, revealed by elective (n=17) or urgent (n=3) coronary angiography (CAG). The overall number of PCI procedures was 26, including 8 with stent implantation. procedures were performed 9-151 (median 61.5) months after OHT. Analysis of PCI results was based on the follow-up CAGs or autopsy in case of death.


RESULTS
Follow-up time was 3-90 (median 28) months. At least one CAG was performed in 17 (85%) patients - the overall number of follow-up CAGs was 53. Progression of TxCAD was revealed by 33 (62%) CAGs - the decision to perform subsequent single or multiple PCI was undertaken in 22 (42%) patients. The overall number of re-PCI procedures was 38 (with stent implantation in 11 cases). Out of 38 PCI procedures without stent implantation, significant restenosis was found on control CAG in 16 (42%) patients, and out of 16 PCI with stents -- in 11 (69%) patients, including 8 haemodynamically significant lesions. TxCAD was the cause of 5 out of 9 deaths that occurred during follow-up.


CONCLUSIONS
PCI is unable to stop TxCAD development in the majority of patients. Stent implantation does not improve long-term results of TxCAD treatment.
Zakliczyński
Michał
M
Department of Cardiac Surgery and Transplantation, Silesian Center for Heart Disease, Zabrze.
Swierad
Marcin
M
Lekston
Andrzej
A
Maruszewski
Marcin
M
Zakliczyńska
Helena
H
Barańska-Kosakowska
Anna
A
Przybylski
Roman
R
Kalarus
Zbigniew
Z
Poloński
Lech
L
Zembala
Marian
M
D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents