Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Cardiac allograft vasculopathy (CAV) is one of the major factors limiting long-term survival after HTx. The use of angioplasty and drug-eluting stents is common after HTx. CAV of the left main (LM) coronary artery is known to have high mortality risk. The long-term outcome of stenting for LM disease has not been well evaluated in this cohort of patients.
*Methods: Between 2010 and 2013 we assessed 37 heart transplant patients who underwent stenting of the LM coronary artery post-transplant. A non-left main (no LM disease with another coronary artery stented) population was included (n=27) for comparison. Outcomes included 5-year freedom from restenosis (≥50% stent stenosis) subsequent 5-year survival, subsequent 5-year freedom from any myocardial infarction, and subsequent 5-year freedom from further deterioration in left ventricular function by echocardiogram.
*Results: Subsequent 5-year freedom from restenosis and freedom from further deterioration in LV function was significantly lower in the LM stented group (see table). There was no difference in subsequent 5-year survival or freedom from myocardial infarction.
*Conclusions: Patients with left main stenting appear to be have acceptable survival after heart transplantation despite progression to a lower left ventricular function and more restenosis. Alternatives to treatment for significant LM disease such as coronary bypass surgery and re-transplantation are not practical options in this diffuse disease and scarcity of donor hearts.
|Endpoints||Left Main Stent (n=37)||Non-LM Stent (n=27)||Log-Rank P-Value|
|Subsequent 5-Year Freedom from Restenosis||81.0%||88.9%||0.028|
|Subsequent 5-Year Survival||60.0%||69.7%||0.584|
|Subsequent 5-Year Freedom from Myocardial Infarction||68.4%||86.9%||0.282|
|Subsequent 5-Year Freedom from Further Deterioration in LV Function||51.5%||86.4%||0.031|
To cite this abstract in AMA style:Dimbil S, Patel J, Azarbal B, Kittleson M, Levine R, Chang DH, Kobashigawa JA. Outcome Of Left Main Stenting After Heart Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcome-of-left-main-stenting-after-heart-transplantation/. Accessed November 26, 2020.
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