Percutaneous coronary interventions in cardiac allograft vasculopathy: a single-center experience.
OBJECTIVE
Cardiac allograft vasculopathy represents an accelerated form of obstructive coronary disease. It is the main cause of late death following heart transplantation. Percutaneous coronary intervention is considered a palliative procedure due to high restenosis rates. The aim of this study was to review our experience with percutaneous coronary interventions using stents in cardiac transplant recipients.


METHODS
The present analysis included all primary adult heart transplanted patients who had been discharged from the hospital after transplantation, had a clinical follow-up of 12 months and underwent percutaneous coronary intervention (PCI).


RESULTS
Seventy heart transplanted patients underwent percutaneous revascularization. Our analysis comprised 85 first-vessel procedures resulting in treatment of 135 lesions. The mean time from heart transplantation to first intervention was 9.3 +/- 4.8 years. Primary success was obtained in 96% lesions; at least 1 recurrent stenosis event occurred in 16 patients with primarily successful PCI. Lesions treated with drug-eluting stents experienced recurrent stenosis in 16% of cases. During a mean follow-up after PCI of 45.2 +/- 41.7 months, 27 deaths (19 cardiac) and 1 late re-transplantation occurred after PCI.


CONCLUSIONS
In cardiac transplant recipients, percutaneous coronary intervention with stents can be performed safely with high rates of primary success. Restenosis rates were higher compared with coronary interventions in native coronary arteries. Drug-eluting stents seemed to favorably impact restenosis compared with bare-metal stents. The clinical benefit from percutaneous coronary intervention may be reduced due to disease progression in untreated coronary segments.
A De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
P
P
Colombo
G
G
Bruschi
A
A
Sacco
J
J
Oreglia
F
F
De Marco
T
T
Colombo
L
L
Botta
F
F
Macera
F
F
Turazza
M
M
Frigerio
L
L
Martinelli
S
S
Klugmann
D000293:Adolescent; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001706:Biopsy; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000473:pathology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000628:therapy*
D007166:Immunosuppressive Agents