心脏移植受者的冠状动脉血管成形术、斑块旋切术和搭桥手术。

Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients.

作者信息

Halle A A, DiSciascio G, Massin E K, Wilson R F, Johnson M R, Sullivan H J, Bourge R C, Kleiman N S, Miller L W, Aversano T R

机构信息

Virginia Commonwealth University, Richmond 23298-0036, USA.

出版信息

J Am Coll Cardiol. 1995 Jul;26(1):120-8. doi: 10.1016/0735-1097(95)00124-i.

DOI:10.1016/0735-1097(95)00124-i

PMID:7797740

Abstract

OBJECTIVES

This study sought to analyze the outcomes of revascularization procedures in the treatment of allograft coronary disease.

BACKGROUND

Allograft vasculopathy is the main factor limiting survival of heart transplant recipients. Because no medical therapy prevents allograft atherosclerosis, and retransplantation is associated with suboptimal allograft survival, palliative coronary revascularization has been attempted.

METHODS

Thirteen medical centers retrospectively analyzed their complete experience with percutaneous transluminal coronary angioplasty, directional coronary atherectomy and coronary bypass graft surgery in allograft coronary disease.

RESULTS

Sixty-six patients underwent coronary angioplasty. Angiographic success (< or = 50% residual stenosis) occurred in 153 (94%) of 162 lesions. Forty patients (61%) are alive without retransplantation at 19 +/- 14 (mean +/- SD) months after angioplasty. The consequences of failed revascularization were severe. Two patients sustained periprocedural myocardial infarction and died. Angiographic restenosis occurred in 42 (55%) of 76 lesions at 8 +/- 5 months after angioplasty. Angiographic distal arteriopathy adversely affected allograft survival. Eleven patients underwent directional coronary atherectomy. Angiographic success occurred in 9 (82%) of 11 lesions. Two periprocedural deaths occurred. Nine patients are alive without transplantation at 7 +/- 4 months after atherectomy. Bypass graft surgery was performed in 12 patients. Four patients died perioperatively. Seven patients are alive without retransplantation at 9 +/- 7 months after operation.

CONCLUSIONS

Coronary revascularization may be an effective palliative therapy in suitable cardiac transplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underwent atherectomy and coronary bypass surgery, assessment of these procedures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization.

摘要

目的

本研究旨在分析血管重建术治疗移植心脏冠状动脉疾病的疗效。

背景

移植血管病变是限制心脏移植受者生存的主要因素。由于尚无药物疗法可预防移植心脏动脉粥样硬化，且再次移植的异体移植心脏生存率欠佳，因此已尝试进行姑息性冠状动脉血管重建术。

方法

13个医学中心回顾性分析了它们在移植心脏冠状动脉疾病患者中进行经皮腔内冠状动脉成形术、定向冠状动脉斑块旋切术和冠状动脉搭桥手术的全部经验。

结果

66例患者接受了冠状动脉成形术。162处病变中有153处（94%）血管造影显示成功（残余狭窄≤50%）。40例患者（61%）在冠状动脉成形术后19±14（平均±标准差）个月存活且未再次移植。血管重建术失败的后果严重。2例患者发生围手术期心肌梗死并死亡。76处病变中有42处（55%）在冠状动脉成形术后8±5个月出现血管造影显示的再狭窄。血管造影显示的远端动脉病变对移植心脏的生存产生不利影响。11例患者接受了定向冠状动脉斑块旋切术。11处病变中有9处（82%）血管造影显示成功。发生2例围手术期死亡。9例患者在斑块旋切术后7±4个月存活且未进行移植。12例患者接受了冠状动脉搭桥手术。4例患者在围手术期死亡。7例患者在手术后9±7个月存活且未再次移植。