Perrotta S, Lentini S, Muré P, Rinaldi M, D'Armini A M, Viganó M
Department of Cardiothoracic Surgery, ''G Martino'' University Hospital, Messina, Italy
Minerva Chir. 2008 Oct;63(5):321-7.
Cardiac transplant vasculopathy is a limit to long-term survival in heart transplantation (H-Tx) recipients. PTCA results in our H-Tx population were retrospectively analyzed.
From November 1985 to May 2004, 767 patients underwent heart transplantation. All patients received immunosuppressive therapy with cyclosporine or tacrolimus, azathioprine, steroids and mycophenolate mofetil. Lymphocyte was administrated by 3-7 days course of either rabbit antithymocyte globulins or anti-lymphocyte globulins or by a 14 days course of OKT3. Coronary angiograms were performed every year and more frequently if graft vasculopathy was already diagnosed or suspected.
Fifty-two coronary artery lesions were treated during 42 percutaneous transluminal cardioangioplasty (PTCA)/stent procedures in 36 patients. Mean time since heart transplantation to PTCA was 80 +/- 27 months. Indication to PTCA was asymptomatic angiographic graft vasculopathy in 34 patients (94%) and acute myocardial infarction in 2 patients (6%). PTCA was performed on left anterior descending artery in 34 cases (65.4%), on circumflex artery in 10 cases (19.2%), on right coronary artery in 8 cases (15.4%). There were no procedure related deaths. None of the patients required emergency bypass surgery. Two patients had transient acute renal failure. Patient follow-up showed 10 deaths after 1 +/- 54 months from PTCA. Six died for progression of graft vasculopathy, three for cancer and one for gastrointestinal bleeding. Two patients underwent heart retransplantation after 20 and 107 months from the first procedure. Mean follow-up of the remaining patients is 78.3 +/- 50.3 months.
PTCA may represent a reasonable treatment for graft vasculopathy in selected heart transplant recipients.
心脏移植血管病变是限制心脏移植（H-Tx）受者长期存活的因素。对我们心脏移植人群的经皮冠状动脉腔内血管成形术（PTCA）结果进行回顾性分析。
1985年11月至2004年5月，767例患者接受了心脏移植。所有患者均接受环孢素或他克莫司、硫唑嘌呤、类固醇和霉酚酸酯的免疫抑制治疗。淋巴细胞通过3 - 7天疗程的兔抗胸腺细胞球蛋白或抗淋巴细胞球蛋白给药，或通过14天疗程的OKT3给药。每年进行冠状动脉造影，如果已诊断或怀疑有移植血管病变，则更频繁地进行。
36例患者在42次经皮冠状动脉腔内血管成形术（PTCA）/支架置入术中治疗了52处冠状动脉病变。从心脏移植到PTCA的平均时间为80±27个月。PTCA的指征为34例患者（94%）无症状血管造影移植血管病变和2例患者（6%）急性心肌梗死。34例（65.4%）在左前降支进行PTCA，10例（19.2%）在回旋支进行，8例（15.4%）在右冠状动脉进行。无手术相关死亡。所有患者均无需急诊搭桥手术。2例患者出现短暂性急性肾衰竭。患者随访显示，PTCA后1±54个月有10例死亡。6例死于移植血管病变进展，3例死于癌症，1例死于胃肠道出血。2例患者在首次手术后20个月和107个月接受了再次心脏移植。其余患者的平均随访时间为78.3±50.3个月。
PTCA可能是部分心脏移植受者移植血管病变的合理治疗方法。
