Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients
| Autor: | Maryl R. Johnson, Leslie W. Miller, Germano DiSciascio, Thomas Aversano, Ross A. Davies, Neal S. Kleiman, Robert C. Bourge, Michael J. Cowley, Gustavo Rincon, Sharon A. Hunt, Chauncey C. Crandall, Susan G. Fisher, Spencer H. Kubo, Edward K. Massin, Mark W. Weston, Robert B. Wray, George W. Vetrovec, Robert F. Wilson, A. Arthur Halle, Henry J. Sullivan |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Atherectomy Coronary Male medicine.medical_specialty Adolescent medicine.medical_treatment Coronary Disease Revascularization Atherectomy Recurrence Internal medicine Angioplasty Myocardial Revascularization medicine Humans Myocardial infarction Angioplasty Balloon Coronary Coronary Artery Bypass Aged Retrospective Studies Heart transplantation business.industry Retrospective cohort study Middle Aged medicine.disease Survival Analysis Surgery Transplantation Treatment Outcome Bypass surgery Cardiology Heart Transplantation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American College of Cardiology. 26:120-128 |
| ISSN: | 0735-1097 |
| Popis: | Objectives. This study sought to analyze the outcomes of revascularization procedures in the treatment of allograft coronary disease. Background. Allograft vasculopathy is the main factor limiting survival of heart transplant recipients. Because no medical therapy prevents allograft atherosclerosis, and retransplantation is associated with suboptimal allograft survival, palliative coronary revascularization has been attempted. Methods. Thirteen medical centers retrospectively analyzed their complete experience with percutaneous transluminal coronary angioplasty, directional coronary atherectomy and coronary bypass graft surgery in allograft coronary disease. Results. Sixty-six patients underwent coronary angioplasty. Angiographic success (≤ 50% residual stenosis) occurred in 153 (94%) of 162 lesions. Forty patients (61%) are alive without retransplantation at 19 ± 14 (mean ± SD) months after angioplasty. The consequences of failed revascularization were severe. Two patients sustained periprocedural myocardial infarction and died. Angiographic restenosis occurred in 42 (55%) of 76 lesions at 8 ± 5 months after angioplasty. Angiographic distal arteriopathy adversely affected allograft survival. Eleven patients underwent directional coronary atherectomy. Angiographic success occurred in 9 (82%) of 11 lesions. Two periprocedural deaths occurred. Nine patients are alive without transplantation at 7 ± 4 months after atherectomy. Bypass graft surgery was performed in 12 patients. Four patients died perioperatively. Seven patients are alive without retransplantation at 9 ± 7 months after operation. Conclusions. Coronary revascularization may be an effective palliative therapy in suitable cardiac transplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underwent atherectomy and coronary bypass surgery, assessment of these procedures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization. |
| Databáze: | OpenAIRE |
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