title: Percutaneous coronary artery revascularization procedures in pediatric heart transplant recipients: A large single center experience.
abstract: OBJECTIVE
  To describe our experience, at a large pediatric heart transplant center, with percutaneous coronary interventions (PCI) for cardiac allograft vasculopathy (CAV).
  
  
  BACKGROUND
  CAV is a leading cause of late graft failure, mortality, and re-transplantation in pediatric heart transplant (HTx) recipients. Studies of PCI in adult patients have shown some short-term improvements, but no significant change in long-term outcomes. There are limited data on PCI for CAV in pediatric patients. We describe the largest single-center experience to date.
  
  
  METHODS
  We performed a retrospective chart review of all pediatric HTx recipients who underwent PCI for a diagnosis of CAV from 2005 to 2014.
  
  
  RESULTS
  Twenty-three procedures were performed in 13 patients, at a median age of 16.4 years (range 5.6-21.2) and median time from HTx to first PCI of 8.3 years (range 2.9-20.3). Three cases consisted of angioplasty alone, two cases had bare metal stents implanted, and the remaining 18 had drug-eluting stents implanted. There was acute procedural success in all but one case, and there was only one procedure-related complication (rebleeding from access site). During the follow-up interval (median 10.4 months, range 0.2-111.8), 7/13 patients had repeat PCI performed, two patients died (at 1.8 and 5.8 months post-PCI), and five were re-transplanted (range 0.2-18 months post-PCI). Freedom from death or retransplant by Kaplan-Meier analysis was 54% at 1 year.
  
  
  CONCLUSIONS
  PCI can be performed safely and effectively in pediatric HTx recipients with CAV. Similar to the adult experience, there remains a high rate of disease progression and graft failure. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Mariel E
authors.initials: ME
authors.lastname: Turner
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Addonizio
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Warren A
authors.initials: WA
authors.lastname: Zuckerman
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.affiliation: Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Torres
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D018450:Disease Progression; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: cardiac allograft vasculopathy; heart transplantation; pediatric intervention; percutaneous coronary intervention