Palliation of allograft vasculopathy with transluminal angioplasty

Benza, Raymond L.; Zoghbi, Gilbert J.; Tallaj, José; Brown, Robert N.; Kirklin, James K.; Hubbard, M.; Rayburn, Barry K.; Foley, Brian A.; McGiffin, David C.; Pinderski, Laura J.; Misra, Vijay K.; Bourge, Robert C.

doi:10.1016/j.jacc.2004.02.045

Cited by 76 publications

(8 citation statements)

References 34 publications

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“…Moreover, other factors beyond immune mechanisms contribute to the development of CAV (2,3). Some observational studies suggest a relationship between cyclosporine dose and freedom from CAV (66), and intensified immunosuppression may be helpful in reducing the risk of restenosis after percutaneous revascularization (63). PSIs have been shown to be effective in reducing the progression of CAV in de novo heart transplant recipients.…”

Section: S8mentioning

confidence: 99%

Cardiac Allograft Vasculopathy: Differences in De Novo and Maintenance Heart Transplant Recipients

et al. 2006

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Advances in immunosuppressive therapies in the past decade have improved short-term survival following heart transplantation, but cardiac allograft vasculopathy (CAV) has remained a major cause of mortality and morbidity in the long-term. CAV is often underdiagnosed by coronary angiography; intravascular ultrasound (IVUS) is currently the gold standard for diagnosis of CAV, with an increase in maximal intimal thickness of Ն0.5 mm from baseline to one year post-transplant representing a risk factor for the incidence of cardiac events during follow-up. Non-invasive tests such as stress echocardiography or scintigraphy evaluate the impact of CAV on myocardial function and/or perfusion. They provide useful prognostic information and may serve as screening tests for selecting patients who need invasive evaluation. The need for effective strategies to prevent CAV, and control its progression once established, is of utmost importance to improve long-term survival and quality of life after heart transplantation. Proliferation signal inhibitors (PSIs) have been demonstrated to slow the development of CAV and to reduce the rate of cardiac events in de novo heart transplant recipients. In maintenance patients, palliation of the disease with percutaneous revascularization is being attempted with increasing frequency, with satisfactory short-term success and possible but unproven long-term benefit. A pilot, single-center, randomized study with sirolimus versus standard care suggests that PSIs may also be effective in limiting the progression of established CAV, validating the need for this hypothesis to be explored in larger trials.

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Section: S8mentioning

confidence: 99%

Cardiac Allograft Vasculopathy: Differences in De Novo and Maintenance Heart Transplant Recipients

et al. 2006

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“…The cumulative results of a single center during a 10-year period show patency rates of 67% at 3 months and 28% at 8 months. 10 It is believed that CAV, which involves fibrous infiltration of the intima, media, and adventitia, leads to negative remodeling after balloon angioplasty. 11 Stents have improved the patency rate of percutaneous revascularization in heart transplant patients, mainly because of greater acute gain and because of their effectiveness in preventing negative remodeling.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Unprotected Left Main Coronary Artery Stenosis in a 5-Year-Old Heart Transplant Patient Using a Sirolimus-Eluting Stent

Salloum

Dodd

Slosky

et al. 2007

The Journal of Heart and Lung Transplantation

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“…In contrast to native coronary disease, CAV is progressive and revascularization procedures are only palliative with no survival benefit [159,160] . Moreover, the concentric, diffuse and distal nature of CAV precludes the majority of patients for revascularization procedures.…”

Section: Coronary Revascularizationmentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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Palliation of allograft vasculopathy with transluminal angioplasty

Abstract: Despite the increasing effectiveness of PCI for localized ACD, the survival after development of advanced ACD remains poor. Stents appear to increase effectiveness of PCI for ACD, but other factors in the current era contribute to improved outcomes.

Cited by 76 publications

References 34 publications

Cardiac Allograft Vasculopathy: Differences in De Novo and Maintenance Heart Transplant Recipients

Cardiac Allograft Vasculopathy: Differences in De Novo and Maintenance Heart Transplant Recipients

Treatment of Unprotected Left Main Coronary Artery Stenosis in a 5-Year-Old Heart Transplant Patient Using a Sirolimus-Eluting Stent

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

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