title: Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Heart Transplant Recipients With Transplant Coronary Arterial Vasculopathy.
abstract: BACKGROUND
  Transplant coronary arterial vasculopathy (TCAV) is a major cause of death after heart transplantation (HTx). Palliative coronary revascularization has been attempted in patients with severe TCAV; however, the outcome has not been fully elucidated.
  
  
  METHODS
  Ninety-six patients who were treated after HTx at our institute between 1999 and 2015 were screened for TCAV. TCAV was defined as >70% stenosis on coronary angiography (CAG) or a maximal intimal thickness of >0.5 mm in the right or left coronary arteries on intracoronary ultrasonography (IVUS). In the present study, the outcomes of patients with severe TCAV who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were investigated.
  
  
  RESULTS
  TCAV containing donor-transmitted atherosclerosis was cumulatively found in 69 patients (71.9% of the total; mean age, 34.6 ± 13.1 years; 52 men; mean follow-up duration, 83.0 ± 60.4 months). Five (7.2%) and 64 (92.8%) of the 69 patients were diagnosed as having TCAV by use of CAG and IVUS, respectively. All 5 patients diagnosed by with the use of CAG underwent coronary revascularization between 1 and 236 months after HTx. Three patients underwent PCI with drug-eluting stents, with a primary success rate of 100%. No angiographic restenosis occurred in 2 patients at 31 and 36 months after PCI, respectively. Meanwhile, 2 patients underwent CABG. No peri-operative complications occurred, and all grafts were patent as assessed by use of CAG at 34 and 5 months after CABG.
  
  
  CONCLUSIONS
  Coronary revascularization was feasible and effective for severe TCAV with middle-term follow-up.
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kkensuke0125@ncvc.go.jp.
authors.forename: K
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sunami
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000209:etiology* / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult