Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

Castleberry, A.W.; Martin, Jt T.; Osho, Aa A.; Hartwig, M.; Hashmi, Za A.; Zanotti, Giorgio; Shaw, LK; Williams, J; Lin, S.S.; Davis, R. Benjamin

doi:10.1111/ajt.12435

Cited by 48 publications

(46 citation statements)

References 31 publications

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“…We strive to correct risk factors for progression of CAD (diabetes mellitus, hypertension, and obesity) in all our recipients. We treat severe coronary artery disease in patients with no other disqualifying comorbidities with either pretransplant PCI or concurrent CABG at the time of transplant, if their left ventricular ejection fraction is normal and there is suitable coronary anatomy for revascularization ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Mild-to-Moderate Coronary Artery Disease Does Not Affect Long-Term Outcomes of Lung Transplantation

et al. 2014

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Background Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined. Methods All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization. Results Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411). Conclusions Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity.

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Section: Discussionmentioning

confidence: 99%

“…Several authors have investigated the effects of CAD and coronary revascularization on lung transplantation outcomes ( 3, 5-8 ). Our study is the first one to investigate the impact of Mod-CAD on survival and morbidity after lung transplant by analyzing a large cohort of patients with a long-term, postoperative follow-up.…”

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confidence: 99%

Preoperative Mild-to-Moderate Coronary Artery Disease Does Not Affect Long-Term Outcomes of Lung Transplantation

et al. 2014

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“…In the case of BLTR, atherosclerotic diseases are potentially accelerated by immunosuppressive therapy (Kasiske, 1988;Hruban et al, 1990). Then, coronary artery diseases are not uncommon in BLTR (Reed et al, 2012;Castleberry et al, 2013).…”

Section: Cadenced Breathingmentioning

confidence: 99%

Heart rate variability and baroreflex sensitivity in bilateral lung transplant recipients

Fontolliet

Gianella

Pichot

et al. 2018

Clin Physio Funct Imaging

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The effects of lung afferents denervation on cardiovascular regulation can be assessed on bilateral lung transplantation patients. The high-frequency component of heart rate variability is known to be synchronous with breathing frequency. Then, if heart beat is neurally modulated by breathing frequency, we may expect disappearance of high frequency of heart rate variability in bilateral lung transplantation patients. On 11 patients and 11 matching healthy controls, we measured R-R interval (electrocardiography), blood pressure (Portapres ) and breathing frequency (ultrasonic device) in supine rest, during 10-min free breathing, 10-min cadenced breathing (0·25 Hz) and 5-min handgrip. We analysed heart rate variability and spontaneous variability of arterial blood pressure, by power spectral analysis, and baroreflex sensitivity, by the sequence method. Concerning heart rate variability, with respect to controls, transplant recipients had lower total power and lower low- and high-frequency power. The low-frequency/high-frequency ratio was higher. Concerning systolic, diastolic and mean arterial pressure variability, transplant recipients had lower total power (only for cadenced breathing), low frequency and low-frequency/high-frequency ratio during free and cadenced breathing. Baroreflex sensitivity was decreased. Denervated lungs induced strong heart rate variability reduction. The higher low-frequency/high-frequency ratio suggested that the total power drop was mostly due to high frequency. These results support the hypothesis that neural modulation from lung afferents contributes to the high frequency of heart rate variability.

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“…With increasing age, these patients may have additional comorbid disease burden, such as concomitant coronary artery disease requiring intervention. 17 Notably, a recent analysis confirmed that older IPF recipients with the higher functional status were more likely to benefit from receiving a BOLT but older IPF recipients with a reduced pre-operative functional status do not appear to derive similar benefit from BOLT. 18 Another report indicated that patients with IPF who are only listed for BOLT are less likely to receive a suitable organ and more likely to die on the waitlist.…”

Section: Discussionmentioning

confidence: 97%

Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time

Hartwig

Ganapathi

Osho

et al. 2016

American Journal of Transplantation

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The choice of single or bilateral lung transplant for interstitial lung disease (ILD) is controversial as surgical risk, long term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates staged bilateral lung transplant recipients (n=12) have a higher LAS, lower pulmonary function tests and lower glomerular filtration rate prior to the first transplant compared to the second (p<0.01). There was a shorter length of hospital stay for the second transplant (p=0.02). The staged bilateral compared to single and bilateral case matched controls had comparable short-term survival (p=0.20) and pulmonary function tests at one year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.

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Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

Cited by 48 publications

References 31 publications

Preoperative Mild-to-Moderate Coronary Artery Disease Does Not Affect Long-Term Outcomes of Lung Transplantation

Preoperative Mild-to-Moderate Coronary Artery Disease Does Not Affect Long-Term Outcomes of Lung Transplantation

Heart rate variability and baroreflex sensitivity in bilateral lung transplant recipients

Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time

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