This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Halle, A. A. Articles by Walford, G. D. Search for Related Content PubMed PubMed Citation Articles by Halle, A. A., 3d Articles by Walford, G. D.

Circulation, Vol 86, 458-462, Copyright © 1992 by American Heart Association

ARTICLES

Coronary angioplasty in cardiac transplant patients. Results of a multicenter study

AA Halle 3d, RF Wilson, EK Massin, RC Bourge, ML Stadius, MR Johnson, RB Wray, JB Young, RA Davies and GD Walford
Department of Medicine, Medical College of Virginia, Richmond.

BACKGROUND. Accelerated allograft atherosclerosis is the main cause of death of cardiac transplant recipients after the first year after transplantation. Because no medical therapy is known to prevent or retard graft atherosclerosis and transplantation is associated with a shortened allograft survival, alternative, palliative therapy with percutaneous transluminal coronary angioplasty (PTCA) has been attempted. Because no single medical center has performed angioplasty in a large number of cardiac transplant recipients, representatives of 11 medical centers retrospectively analyzed their complete experience of coronary angioplasty in cardiac transplant patients to determine the safety, efficacy, limitations, and long-term outcome of angioplasty in allograft coronary vascular disease. METHODS AND RESULTS. Thirty-five patients underwent 51 angioplasty procedures for 95 lesions 46 +/- 5 months (mean +/- SEM) after transplantation. The primary indications for angioplasty included angiographic coronary disease in 22 cases (43%) and noninvasive evidence of ischemia in 18 procedures (35%). Angiographic success, defined as less than or equal to 50% post-PTCA stenosis, occurred in 88 of 95 lesions (93%). Mean pre-PTCA stenosis was 83 +/- 1.1%; mean post-PTCA stenosis was 29 +/- 2.1% (p less than 0.0001). Periprocedural complications included myocardial infarction and late in-hospital death in one patient and three groin hematomas. Twenty-three of the 35 patients (66%) had no major adverse outcome such as death, retransplantation, or myocardial infarction at 13 +/- 3 months after angioplasty. Four patients died less than 6 months after angioplasty, and four died more than 6 months after angioplasty (range, 6-23 months). Two patients had retransplantation 2 months after PTCA, and one patients had retransplantation 18 months after angioplasty. CONCLUSIONS. Coronary angioplasty may be applied in selected cardiac transplant recipients with comparable success and complication rates to routine angioplasty. Whether angioplasty prolongs allografts survival remains to be determined by a prospective, controlled trial.

This article has been cited by other articles:

				M. Jonas, J. C. Fang, J. C. Wang, S. Giri, D. Elian, Y. Har-Zahav, H. Ly, P. A. Seifert, J. J. Popma, and C. Rogers In-Stent Restenosis and Remote Coronary Lesion Progression Are Coupled in Cardiac Transplant Vasculopathy But Not in Native Coronary Artery Disease J. Am. Coll. Cardiol., August 1, 2006; 48(3): 453 - 461. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				D. A. Rossignol, B. Kipreos, K. Akosah, and P. K. Mohanty Accelerated Transplant Coronary Artery Disease and Massive Silent Acute Myocardial Infarction in a Heart Transplant Patient: A Case Report and Brief Review of Literature Angiology, November 1, 1999; 50(11): 947 - 953. [Abstract] [PDF]

				M. Musci, M. Pasic, R. Meyer, M. Loebe, E. Wellnhofer, Y. Weng, H. Kuppe, and R. Hetzer Coronary artery bypass grafting after orthotopic heart transplantation Eur. J. Cardiothorac. Surg., August 1, 1999; 16(2): 163 - 168. [Abstract] [Full Text] [PDF]

				R. John, J. M. Chen, A. Weinberg, M. C. Oz, D. Mancini, S. Itescu, M. E. Galantowicz, C. R. Smith, E. A. Rose, and N. M. Edwards Long-Term Survival After Cardiac Retransplantation: A Twenty-Year Single-Center Experience J. Thorac. Cardiovasc. Surg., March 1, 1999; 117(3): 543 - 555. [Abstract] [Full Text] [PDF]

				M. Weis and W. von Scheidt Cardiac Allograft Vasculopathy : A Review Circulation, September 16, 1997; 96(6): 2069 - 2077. [Abstract] [Full Text]