Prior and Perioperative Revascularization Does Not Affect Survival in Lung Transplant Patients

Coronary artery disease in lung transplant patients

“…Cardiac revascularization before noncardiac surgeries is recommended in the same circumstances as it would be indicated even without the surgery and not to solely decrease intraoperative and postoperative cardiac events 4 . Risk mitigation strategies for CAD in lung transplant candidates include percutaneous coronary interventions (PCI) prior to the transplant and, if there is multivessel CAD or an anatomy unsuitable for PCI, coronary artery bypass graft (CABG) either pre‐transplant or concomitant to the transplant 27 . One study described the safe effect of performing CABG even before listing the patients for transplant, 28 since concomitant CABG might risk organ loss and requires a specialized team.…”

“…Hospitals in the United States that uses Coronary Angiography (CA) in the perioperative evaluation of lung transplant candidates Louisiana Pt > 45 y.o. or < 45 y.o with > 2 risk factors Seoane, et al 19 Patients undergoing evaluation for lung transplant that present with ≥ 2 of the following risk factors require further workup Risk mitigation strategies for CAD in lung transplant candidates include percutaneous coronary interventions (PCI) prior to the transplant and, if there is multivessel CAD or an anatomy unsuitable for PCI, coronary artery bypass graft (CABG)either pre-transplant or concomitant to the transplant 27. One study described the safe effect of performing CABG even before listing the patients for transplant,28 since concomitant CABG might risk organ loss and requires a specialized team.…”

“…They safely transplanted these patients, but revascularized patients were faced with perioperative complications like increased ICU stay 21. Kanaparthi et al results suggested that patients with CAD that received revascularization, either by PCI, previous CABG or concomitant CABG, show similar rates of survival to those who did not need revascularization 27. Sherman et al reported no statistical significance in medium term survival at 3 years post-transplant in CAD patients that were matched to non-CAD patients 45.…”

Adding complexity to complexity: The role of concomitant cardiac surgery in lung transplantation

“…Risk mitigation strategies for CAD in lung transplant candidates include PCI before the transplant and, if there is multivessel CAD or anatomy unsuitable for PCI, coronary artery bypass graft (CABG) either pretransplant or concomitant to the transplant. A recent report by Kanaparthy et al suggests that preoperative or intraoperative revascularization does not negatively affect survival in lung transplant patients 5 …”

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

“…This comorbidity can pose major challenges for LTx management, not only due to the likelihood of perioperative myocardial stress and hemodynamic instability but also because postoperative immunosuppression may accelerate the atherosclerotic process. Kanaparthi et al 2 performed a single-center, retrospective analysis to evaluate the impact of prior or perioperative coronary revascularization on survival in LTx recipients. The cohort (n = 468) was divided into 4 groups: preoperative percutaneous intervention (n = 34), preoperative coronary artery bypass grafting (CABG; n = 25), concomitant CABG during LTx (n = 29), and patients undergoing LTx with no indication for coronary revascularization (n = 380).…”