Colombo P, Bruschi G, Sacco A, Oreglia J, De Marco F, Colombo T, Botta L, Macera F, Turazza F, Frigerio M, Martinelli L, Klugmann S
A De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Transplant Proc. 2010 May;42(4):1286-90. doi: 10.1016/j.transproceed.2010.03.065.
Cardiac allograft vasculopathy represents an accelerated form of obstructive coronary disease. It is the main cause of late death following heart transplantation. Percutaneous coronary intervention is considered a palliative procedure due to high restenosis rates. The aim of this study was to review our experience with percutaneous coronary interventions using stents in cardiac transplant recipients.
The present analysis included all primary adult heart transplanted patients who had been discharged from the hospital after transplantation, had a clinical follow-up of 12 months and underwent percutaneous coronary intervention (PCI).
Seventy heart transplanted patients underwent percutaneous revascularization. Our analysis comprised 85 first-vessel procedures resulting in treatment of 135 lesions. The mean time from heart transplantation to first intervention was 9.3 +/- 4.8 years. Primary success was obtained in 96% lesions; at least 1 recurrent stenosis event occurred in 16 patients with primarily successful PCI. Lesions treated with drug-eluting stents experienced recurrent stenosis in 16% of cases. During a mean follow-up after PCI of 45.2 +/- 41.7 months, 27 deaths (19 cardiac) and 1 late re-transplantation occurred after PCI.
In cardiac transplant recipients, percutaneous coronary intervention with stents can be performed safely with high rates of primary success. Restenosis rates were higher compared with coronary interventions in native coronary arteries. Drug-eluting stents seemed to favorably impact restenosis compared with bare-metal stents. The clinical benefit from percutaneous coronary intervention may be reduced due to disease progression in untreated coronary segments.
心脏移植血管病变是一种加速进展型的阻塞性冠状动脉疾病。它是心脏移植术后晚期死亡的主要原因。由于再狭窄率高，经皮冠状动脉介入治疗被认为是一种姑息性手术。本研究的目的是回顾我们在心脏移植受者中使用支架进行经皮冠状动脉介入治疗的经验。
本分析纳入了所有成年心脏移植的初治患者，这些患者移植后已出院，临床随访12个月，并接受了经皮冠状动脉介入治疗（PCI）。
70例心脏移植患者接受了经皮血管重建术。我们的分析包括85例首次血管手术，共治疗135处病变。从心脏移植到首次介入的平均时间为9.3±4.8年。96%的病变获得了初步成功；16例PCI初步成功的患者至少发生了1次再狭窄事件。使用药物洗脱支架治疗的病变有16%发生再狭窄。在PCI后的平均随访45.2±41.7个月期间，PCI后发生27例死亡（19例心脏相关）和1例晚期再次移植。
在心脏移植受者中，使用支架进行经皮冠状动脉介入治疗可以安全地进行，且初步成功率较高。与天然冠状动脉的介入治疗相比，再狭窄率更高。与裸金属支架相比，药物洗脱支架似乎对再狭窄有较好的影响。由于未治疗冠状动脉节段的疾病进展,经皮冠状动脉介入治疗的临床获益可能会降低。
