title: Outcomes after percutaneous coronary artery revascularization procedures for cardiac allograft vasculopathy in pediatric heart transplant recipients: A multi-institutional study.
abstract: BACKGROUND
  Cardiac allograft vasculopathy is an important cause of long-term graft loss. In adults, percutaneous revascularization procedures (PRPs) have variable success with high restenosis rates and little impact on graft survival. Limited data exist in pediatric recipients of transplants.
  
  
  METHODS
  Data from the Pediatric Heart Transplant Study (PHTS) were used to explore associations between PRPs and outcomes after heart transplant in patients listed ≤18 years old who received a first heart transplant between 1993 and 2009.
  
  
  RESULTS
  Revascularization procedures were done in 28 of 3,156 (0.9%) patients; 13 patients had multiple PRPs giving a total of 51 PRPs performed across 15 centers. Mean recipient age at time of transplant was 7.7 ± 6.7 years; mean donor age was 15.9 ± 15.4 years. The mean time to first PRP was 5.7 ± 3.2 years. Vessels involved were left anterior descending artery (41%), right coronary artery (25%), circumflex artery (18%), other coronary branches/unknown (16%). PRPs consisted of 38 (75%) stent implantations and 13 (25%) balloon angioplasties with an overall procedural success rate of 73%. Freedom from graft loss after PRPs was 89%, 75%, and 61% at 1, 3, and 12 months. In addition, patients with transplants from donors >30 years old were found to have less freedom from the need for a revascularization procedure than patients with transplants from younger donors (p < 0.0001).
  
  
  CONCLUSIONS
  In this large pediatric heart transplant cohort, use of PRPs for cardiac allograft vasculopathy was rare, likely related to procedural feasibility of the interventions. Despite technically successful interventions, graft loss occurred in 39% within 1 year post-procedure; relisting for heart transplant should be considered.
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: jeewa@bcm.edu.
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Clifford
authors.initials: C
authors.lastname: Chin
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Pahl
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.affiliation: Duke Children's Hospital & Health Center, Durham, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carboni
authors.affiliation: The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pruitt
authors.affiliation: The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.affiliation: Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York.
authors.forename: Rose
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Anne I
authors.initials: AI
authors.lastname: Dipchand
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D015906:Angioplasty, Balloon, Coronary; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003327:Coronary Disease / Q000209:etiology / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome
keywords: allograft; cardiac; heart transplant; pediatric; vasculopathy