Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Cardiology. 2022;147(3):348-363. doi: 10.1159/000524781. Epub 2022 May 2.
Cardiac allograft vasculopathy (CAV) is the primary cause of late mortality after heart transplantation. We look to provide a comprehensive review of contemporary revascularization strategies in CAV.
PubMed and Web of Science were systematically searched by 3 authors. 1,870 articles were initially screened and 24 were included in this review.
PCI is the main revascularization technique utilized in CAV. The pooled estimates for restenosis significantly favored DES over BMS (OR 4.26; 95% CI: 2.54-7.13; p < 0.00001; I2 = 4%). There were insufficient data to quantitatively compare mortality following DES versus BMS. There was no difference in short-term mortality between CABG and PCI. In-hospital mortality was 0.0% for CABG and ranged from 0.0 to 8.34% for PCI. One-year mortality was 8.0% for CABG and 5.0-25.0% for PCI. CABG had a potential advantage at 5 years. Five-year mortality was 17.0% for CABG and ranged from 14 to 40.4% following PCI. Select measures of postoperative morbidity trended toward superior outcomes for CABG.
In CAV, PCI is the primary revascularization strategy utilized, with DES exhibiting superiority to BMS regarding postoperative morbidity. Further investigation into outcomes following CABG in CAV is required to conclusively elucidate the superior management strategy in CAV.
心脏同种异体移植血管病（CAV）是心脏移植后晚期死亡的主要原因。我们旨在对 CAV 中的当代血运重建策略进行全面回顾。
由 3 位作者对 PubMed 和 Web of Science 进行系统检索。最初筛选出 1870 篇文章，其中 24 篇文章纳入本综述。
PCI 是 CAV 中主要的血运重建技术。DES 组再狭窄的汇总估计明显优于 BMS 组（OR 4.26；95%CI：2.54-7.13；p < 0.00001；I2 = 4%）。没有足够的数据对 DES 与 BMS 后死亡率进行定量比较。DES 与 PCI 的短期死亡率无差异。CABG 的院内死亡率为 0.0%，PCI 的范围为 0.0-8.34%。CABG 的 1 年死亡率为 8.0%，PCI 的 1 年死亡率为 5.0-25.0%。CABG 在 5 年内可能具有优势。CABG 的 5 年死亡率为 17.0%，PCI 的范围为 14-40.4%。术后发病率的某些衡量指标倾向于 CABG 的结果更好。
在 CAV 中，PCI 是主要的血运重建策略，DES 在术后发病率方面优于 BMS。需要进一步研究 CABG 在 CAV 中的结果，以明确 CAV 的最佳管理策略。
