Coronary angioplasty and stenting in orthotopic heart transplants: A fruitful act or a futile attempt?

Accelerated allograft coronary artery disease remains the major cause of mo rtality after the first year of transplantation. Despite the extensive use of stents and angioplasty in coronary artery disease, there is a paucity of data about the efficacy of such interventions in orthotopic heart transpla nts. The authors herein report the outcome of those patients in their insti tution who had undergone percutaneous coronary artery angioplasty and stent ing at a late stage of their transplantation. Within a 12-year period, 106 adult patients underwent orthotopic heart transplantation at their institut ion. Eight of these patients with 17 lesions underwent deployment of nine s tents and eight angioplasties 8.1 +/- 3.2 years posttransplantation. There were 15 denovo and two restenotic lesions. The indications for intervention were presence of symptoms in five patients and severity of lesions in thre e asymptomatic patients detected on their follow-up angiogram. All patients had angiographic worsening of lesions at their follow-up angiogram. The in itial procedural success for both stented and angioplastied lesions was 100 %. Within a mean angiographic follow-up of 261 days, all balloon angioplast ied lesions had developed restenosis, whereas within a mean period of 67 da ys, 50% of stented lesions had developed restenosis. On the follow-up angio gram, deterioration of the nontreated segments were noted throughout the co ronary arterial tree; however, the immediate proximal and distal parts of t he target segments demonstrated an exaggerated hyperproliferative response as compared to other sites. The overall median time to the detection of res tenosis for both stented and angioplastied lesions was 5.2 months (inner qu artile 2.5-6.2 months). The authors conclude that angioplasty and stenting late in the course of transplantation is associated with a significant rest enosis rate and in such patients earlier or alternative catheter-based inte rventions must be considered.