CORONARY ANGIOPLASTY, ATHERECTOMY AND BYPASS-SURGERY IN CARDIAC TRANSPLANT RECIPIENTS

Objectives. This study sought to analyze the outcomes of revasculariza tion procedures in the treatment of allograft coronary disease. Backgr ound. Allograft vasculopathy is the main factor limiting survival of h eart transplant recipients. Because no medical therapy prevents allogr aft atherosclerosis, and retransplantation is associated with suboptim al allograft survival, palliative coronary revascularization has been attempted. Methods. Thirteen medical centers retrospectively analyzed their complete experience with percutaneous transluminal coronary angi oplasty, directional coronary atherectomy and coronary bypass graft su rgery in allograft coronary disease. Results. Sixty-six patients under went coronary angioplasty. Angiographic success (less than or equal to 50% residual stenosis) occurred in 153 (94%) of 162 lesions. Forty pa tients (61%) are alive without retransplantation at 19 +/- 14 (mean +/ - SD) months after angioplasty. The consequences of failed revasculari zation were severe. Two patients sustained periprocedural myocardial i nfarction and died. Angiographic restenosis occurred in 42 (55%) of 76 lesions at 8 +/- 5 months after angioplasty. Angiographic distal arte riopathy adversely affected allograft survival. Eleven patients underw ent directional coronary atherectomy. Angiographic success occurred in 9 (82%) of 11 lesions. Two periprocedural deaths occurred. Nine patie nts are alive without transplantation at 7 +/- 4 months after atherect omy. Bypass graft surgery was performed in 12 patients. Four patients died perioperatively. Seven patients are alive without retransplantati on at 9 +/- 7 months after operation. Conclusions. Coronary revascular ization may be an effective palliative therapy in suitable cardiac tra nsplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underw ent atherectomy and coronary bypass surgery, assessment of these proce dures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization.