Format

Send to

Choose Destination
J Heart Lung Transplant. 2015 Sep;34(9):1163-8. doi: 10.1016/j.healun.2014.11.011. Epub 2014 Nov 15.

Outcomes after percutaneous coronary artery revascularization procedures for cardiac allograft vasculopathy in pediatric heart transplant recipients: A multi-institutional study.

Author information

1
Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: jeewa@bcm.edu.
2
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
3
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
4
Medical University of South Carolina, Charleston, South Carolina.
5
Duke Children's Hospital & Health Center, Durham, North Carolina.
6
The University of Alabama at Birmingham, Birmingham, Alabama.
7
Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York.
8
The Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Cardiac allograft vasculopathy is an important cause of long-term graft loss. In adults, percutaneous revascularization procedures (PRPs) have variable success with high restenosis rates and little impact on graft survival. Limited data exist in pediatric recipients of transplants.

METHODS:

Data from the Pediatric Heart Transplant Study (PHTS) were used to explore associations between PRPs and outcomes after heart transplant in patients listed ≤18 years old who received a first heart transplant between 1993 and 2009.

RESULTS:

Revascularization procedures were done in 28 of 3,156 (0.9%) patients; 13 patients had multiple PRPs giving a total of 51 PRPs performed across 15 centers. Mean recipient age at time of transplant was 7.7 ± 6.7 years; mean donor age was 15.9 ± 15.4 years. The mean time to first PRP was 5.7 ± 3.2 years. Vessels involved were left anterior descending artery (41%), right coronary artery (25%), circumflex artery (18%), other coronary branches/unknown (16%). PRPs consisted of 38 (75%) stent implantations and 13 (25%) balloon angioplasties with an overall procedural success rate of 73%. Freedom from graft loss after PRPs was 89%, 75%, and 61% at 1, 3, and 12 months. In addition, patients with transplants from donors >30 years old were found to have less freedom from the need for a revascularization procedure than patients with transplants from younger donors (p < 0.0001).

CONCLUSIONS:

In this large pediatric heart transplant cohort, use of PRPs for cardiac allograft vasculopathy was rare, likely related to procedural feasibility of the interventions. Despite technically successful interventions, graft loss occurred in 39% within 1 year post-procedure; relisting for heart transplant should be considered.

KEYWORDS:

allograft; cardiac; heart transplant; pediatric; vasculopathy

PMID:
25578627
DOI:
10.1016/j.healun.2014.11.011
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center