Second International Joint Meeting of the Francophone Transplantation SocietiesCoronary angioplasty and stenting in cardiac allograft vasculopathy following heart transplantation
Section snippets
Patients and methods
One hundred and five heart transplant patients underwent a total of 350 coronary angiographies, according to a follow-up routine protocol (18-month interval), or motivated by the occurrence of a clinical event. Forty-three patients had angiographic coronary lesions that suggested CAV. Severity of lesions was assessed by quantitative measurement of the coronary artery diameter and minimal lumen diameter stenosis. Measurements were performed after intracoronary infusion of 1 mg of linsidomine.
Primary results
Between July 1994 and July 1998, a total of 37 critical stenoses were dilated during 23 procedures (1.6 dilatations/procedure) in nine patients (2.6 procedures/patient). The dilatation was a conventional PTCA in 22 cases and a stent implantation in 15 cases. Localization of target lesions were: left anterior descending coronary artery (n = 22), circumflex coronary artery (n ± 5), right coronary artery (n = 10). Primary angiographic success (defined as a residual stenosis of less than 50%) was
Discussion
Cardiac allograft vasculopathy is the main cause of late death after heart transplantation. In a series of 54 patients with ≥40% proximal or midvessel coronary stenosis,16 the actuarial survival rate at 6 years was 48% (vs 82% in patients without any coronary lesions) with medical treatment. Both the safety and the benefit of PTCA and coronary stenting for the treatment of CAV with focal proximal stenosis are currently under investigation. These two major interventional catheterization
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