Experience of Percutaneous Coronary Intervention in the Management of Pediatric Cardiac Allograft Vasculopathy

Tham, Edythe B; Yeung, Alan C.; Cheng, Cheung Wah Boron; Bernstein, Daniel; Chin, Clifford; Feinstein, Jeffrey A.

doi:10.1016/j.healun.2004.04.009

Cited by 20 publications

(20 citation statements)

References 16 publications

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“…21,22 Although we did not often utilize percutaneous coronary interventions in this cohort (3 patients), we have subsequently utilized this technique more often for patients with graft CAD, although with limited longterm success. 23 Our current approach is that coronary interventions are utilized most often in conjunction with listing for re-transplant.…”

Section: Discussionmentioning

confidence: 99%

Ten- and 20-year Survivors of Pediatric Orthotopic Heart Transplantation

Ross

Kouretas

Gamberg

et al. 2006

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

Ten- and 20-year Survivors of Pediatric Orthotopic Heart Transplantation

Ross

Kouretas

Gamberg

et al. 2006

The Journal of Heart and Lung Transplantation

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“…The limited experience and reports in the literature make definitive recommendations difficult (57)(58)(59). Due to the diffuse nature of the disease, the majority of patients are not amenable to interventional techniques.…”

Section: Cavmentioning

confidence: 99%

Current state of pediatric cardiac transplantation

Dipchand

2018

Ann. Cardiothorac. Surg.

102

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Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing. The biggest gap impacting both waitlist and overall survival remains mechanical support options for infants and patients with single ventricle physiology. Though acute rejection has decreased progressively, both diagnosis and management of antibody-mediated rejection has become increasingly challenging and complex, as has the ability to understand the implication of anti-HLA antibodies detected both pre-and post-transplantation-including when and how to intervene. Trends in immunosuppression protocols include more use of induction therapy and steroid avoidance or withdrawal protocols. Common long-term morbidities include renal insufficiency, which can be mitigated with surveillance and renal-sparing strategies, and infections. Functional outcomes are excellent, but significant psychosocial challenges exist in relation to neurodevelopment, non-adherence, and transition from childcentered to adult-centered care. Cardiac allograft vasculopathy (CAV) remains a barrier to long-term survival, though it is more apparent that objective evidence of an impact on the allograft is important with regards to impact on outcomes. Retransplantation is rare in pediatric heart transplant recipients. Pediatric heart transplantation continues to evolve in order to address the challenges of the diverse group of patients that reach end-stage heart failure during childhood.

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“…These patients also had successful procedures by angiography; however, all patients subsequently underwent retransplantation. Tham et al 12 reported on a single-center pediatric experience with percutaneous coronary interventions in which 7 patients underwent a revascularization procedure. Major procedural complications in this study included death (n ¼ 1) and a resuscitated cardiac arrest (n ¼ 1).…”

mentioning

confidence: 99%