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J Thorac Cardiovasc Surg 2009;137:1488-1492
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Surgical revascularization for cardiac allograft vasculopathy: Is it still an option?

^a Division of Cardiothoracic Transplantation, Heart, Lung & Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
^b The Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa

Received for publication August 28, 2008; revisions received December 26, 2008; accepted for publication February 3, 2009.

^_* Address for reprints: Jay K. Bhama, MD, 200 Lothrop St, Suite C-900, Heart, Lung & Esophageal Surgery Institute, Division of Cardiothoracic Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213. (Email: bhamajk{at}upmc.edu).

Objectives: Cardiac allograft vasculopathy remains a major cause of mortality after cardiac transplantation. Percutaneous revascularization has become the mainstay of therapy given the poor historical outcomes with surgery. Outcomes following surgical revascularization are evaluated to determine whether surgery remains a viable therapeutic option.

Methods: A retrospective analysis was performed of 13 heart transplant recipients who had cardiac allograft vasculopathy requiring coronary artery bypass grafting with or without adjunctive percutaneous coronary intervention for revascularization from 1999 to 2008.

Results: Thirteen patients had 14 coronary artery bypass grafting procedures at 141 ± 66 months after transplantation. The average number of grafts was 2.3. Eight were performed without cardiopulmonary bypass, of which 5 were approached via left thoracotomy and the remainder via repeat sternotomy. One patient had renal failure and a cerebrovascular accident. Percutaneous coronary intervention before or after coronary artery bypass grafting was required in 3 patients. There were no perioperative mortalities. At mean follow-up of 39 ± 36 months, 3 patients have died, 2 from progressive cardiac allograft vasculopathy and 1 from lung cancer. Kaplan-Meier survival for this group of patients was 92%, 83%, and 83% at 1, 5, and 7 years, respectively.

Conclusions: Surgical revascularization for cardiac allograft vasculopathy remains a viable treatment option for appropriate patients and may be performed safely with good medium-term outcomes. However, patients remain at risk for disease progression and may require percutaneous or surgical reintervention.