Coronary Angioplasty, Bypass Surgery, and Retransplantation in Cardiac Transplant Patients with Graft Coronary Disease

Abstract

The presence of angiographic distal arteriopathy should be considered a significant factor in patient selection for coronary revascularization procedure. Coronary angioplasty is to be considered as a method of treatment for severe, local stenoses (Type A lesion). PTCA may be applied in these selected cardiac transplant recipients with primary success and complication rates comparable to routine angioplasty but with an increased rate of restenosis especially in small vessels (diameter < 2.5 mm). The distinction between Type A lesions in large (diameter > or = 2.5 mm) and small vessels may be important not only with respect to restenosis but also with respect to long-term benefit. The overall survival did not differ between GCD patients with and without PTCA, suggesting this treatment to be largely palliative. (ABSTR

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

“…Surgical revascularization is associated with a very high mortality (up to 40%) [162,167,168] and limited success. Indication is then reserved to highly selected patients.…”

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

“…Registry data demonstrates that CAV significantly contributes to late morbidity and mortality. Due to the lack of significant treatment options (Boucek et al, 2007;Schowengerdt, 2006;Musci et al, 1998;Razzouk et al, 1998;Mulla et al, 2001) 15% of recipients undergo cardiac re-transplant (Ross et al, 2006). Survival after re-transplant, however, is poorer than after a first heart transplant .…”

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

“…Non-pharmacologic treatment includes PCI, coronary artery bypass grafting (CABG), and retransplantation. Percutaneous and surgical revascularization is limited by the diffuse coronary involvement, the infrequency of focal lesions with suitable distal targets, and the high mortality rates with surgical intervention (up to 30-40%) (Musci et al, 1998;Patel et al, 1997). PCI is associated with excellent short-term results, however is associated with high restenosis rates.…”

“…It may be appropriate to perform PCI in patients with discrete focal lesions with abnormal graft function or evidence of stress-induced functional significance by stress imaging. Retransplantation is the only definitive therapy for CAV; however, survival is lower than after primary heart transplant and the probability of CAV in the retransplanted heart is higher than in de novo transplants (up to 50% at 3 years) (Musci et al, 1998;Srivastava et al, 2000). Re-transplantation is reserved for highly selected patients with CAV.…”