Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients

Abstract

Coronary revascularization may be an effective palliative therapy in suitable cardiac transplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underwent atherectomy and coronary bypass surgery, assessment of these procedures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization.

Usefulness and Safety of Percutaneous Coronary Interventions for Cardiac Transplant Vasculopathy

“…1,2 Although various interventional revascularization methods have been used to treat TCAD, it is still unknown whether angioplasty-based therapies prolong cardiac allograft or patient survival. 12,14 The procedural success rate was 93% (145 of 156 lesions) in the present study. Previous studies of PCI for TCAD reported a similar initial success rate.…”

“…Allograft survival (defined as the absence of retransplantation or death) was maintained in 32 of 65 patients (49%) a mean of 35 Ϯ 30 months after the successful initial PCI. In a multicenter review, Halle et al 14 reported in 1995 that 61% (40 of 66 patients) were alive without repeat OHT at 19 Ϯ 14 months after angioplasty, but the Kaplan-Meier actuarial survival was only 20% at 5 years after angioplasty. Several explanations may exist as to why the actuarial survival was improved in the present study; these include alterations in surgical technique, newer medical regimens, and the use of coronary stents and DESs.…”

“…[12][13][14][15][16][17] Advances in immunosuppressive therapy, including rapamycin, and PCI technology with drug-eluting stents (DESs) may be expected to reduce the restenosis rate in TCAD. 18,19 The objective of this study was to analyze the outcome of OHT patients in whom a PCI procedure had been performed at our hospital for treatment of TCAD.…”

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

“…Even though not completely clarified, we believe that allograft vasculopathy results from an immunologically mediated phenomenon aggravated by atherogenic involvement. When the histologic characteristics of the coronary artery lesion are analyzed, we observe a predominance of macrophages and cytotoxic T lymphocytes, proliferation of smooth muscle cells, and myointimal hyperplasia, resulting in concentric luminal stenosis, which is also found in early restenosis following angioplasty 11,12 . Some immune and nonimmune risk factors seem to contribute to the development of the disease; this issue, however, remains controversial.…”

Cutting balloon angioplasty for cardiac transplant vasculopathy

“…This restenosis rate is high compared with conventional balloon angioplasty for cardiac allograft arteriopathy. 4,5,8 We initially suspected the high restenosis rate associated with use of the Cutting Balloon was a manifestation of the aggressive proliferation seen with this patient population rather than a direct effect of Cutting Balloon angioplasty when used in transplanted arteries. However, the Cutting Balloon itself might exacerbate the aggressive tissue proliferation associated with transplant arteriopathy and result in a high restenosis rate.…”