Usefulness and Safety of Percutaneous Coronary Interventions for Cardiac Transplant Vasculopathy

Abstract

Late morbidity and death as a result of progressive coronary vascular obliteration remains a major unsolved problem after orthotopic heart transplantation. Various percutaneous catheter intervention (PCI) methods have been used to treat transplant coronary artery disease (CAD), but few reports have assessed the longitudinal results of these procedures. Of 1,440 cardiac transplant patients at University of California, Los Angeles, Medical Center, treated between 1984 and 2004, 65 patients who had undergone orthotopic heart transplantation underwent PCI on a total of 156 coronary artery lesions because of transplant CAD between July 1993 and August 2004. The procedural success rate was 93%. Angiographic follow-up was available for 42 patients and 101 lesions 9.5 ؎ 5.8 months after PCI. The global restenosis rate was 36%. Multivariate analysis was used to assess 49 clinical, angiographic, and immunologic variables per lesion. The use of a cutting balloon increased the risk of restenosis (odds ratio 11.5, p <0.01) and the use of stents decreased the risk of restenosis (odds ratio 0.34, p <0.05) compared with other PCI methods. The restenosis rate with drugeluting stents was 19%, lower than that with bare metal stents (31%). Of the 65 patients, 20 (31%) died within 1.9 ؎ 1.8 years after PCI. The actuarial survival rate was 56% at 5 years after the first PCI. In conclusion, although the restenosis rate after PCI was higher than that in nontransplant patients with CAD, the immediate and long-term results were acceptable in this high-risk population. Despite the intense inflammation associated with transplant CAD, drug-eluting stents appeared to reduce the occurrence of restenosis. Compared with historical controls, PCI may also improve the actuarial survival rate of patients undergoing orthotopic heart transplantation.

Coronary artery disease in patients after orthotopic heart transplantation treated with percutaneous coronary intervention – a single centre experience

“…The risk of restenosis is perceived to be usually higher in patients after heart transplantation than in the native heart [13]. Aquel et al, Tanaka et al, and Lekston et al demonstrated that DES implantation results in lower risk of restenosis as compared to BMS [14][15][16]. We were not able to confirm that finding, probably due to the relatively small number of patients with only 2 incidents of restenosis.…”

Treatment of Left Main Coronary Artery Stenosis with Drug-Eluting Stent Following Heart Transplantation

“…One of the main concerns of PCI in OHT patients is re-stenosis, as the allografted coronary vessel is in a proinflammatory state, which influences vessel remodeling (13)(14)(15)(16). Multivariate analysis revealed that in allograft vasculopathy, the use of stents decreased the risk of restenosis (odds ratio 0.34, p<0.05) compared with cutting balloon or other PCI methods (10,17). PCI allows a high level of primary success with a low procedural-complication rate (9).…”

“…PCI allows a high level of primary success with a low procedural-complication rate (9). In addition, the restenosis rate with drug-eluting stents is reported to be 15-19%, which is lower than bare metal stent (31%) (10,17).…”

Drug‐eluting stenting of unprotected left main coronary artery stenosis in patients with orthotopic heart transplantation: Initial clinical experience

“…A high restenosis rate may be reflective of the underlying inflammatory nature of TCAD. Two studies reported trends toward lower restenosis rates with DES compared with bare-metal stents in OHT patients [12,45]. In one report, two OHT patients who underwent ULMCA PCI with bare-metal stents for TCAD developed restenosis and underwent coronary artery bypass surgery [34] (Table II).…”