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P14.15 Early preventive “coronary sealing” of transmitted coronary artery disease with stent PTCA to improve outcomes of heart transplantation

Alex O Shevchenko, Russian Federation

Shumakov National Transplant Centre

Abstract

Early preventive “coronary sealing” of transmitted coronary artery disease with stent PTCA to improve outcomes of heart transplantation

Sergey V Gautier1, Alex Shevchenko1, Nadia N Koloskova1, Boris L Mironkov1, Anna J Goncharova1.

1Cardiology, Shumakov National Transplant Centre, Moscow, Russian Federation

Introduction: The prevalence of asymptomatic coronary atherosclerosis in the population is high, and the use of donor hearts from older individuals and “suboptimal” donors increases the likelihood of coronary artery disease (CAD) transmission to the heart recipients. Percutaneous transluminal coronary angioplasty (PTCA) with subsequent stenting improves angina symptoms but has no advantages over medical therapy in the “native heart” CAD patients. We hypothesize that early preventive coronary angioplasty would improve prognosis of the insensitive denervated donor hearts patients.

Objectives: To study the impact of transmitted CAD and preventive angioplasty on the risk of death, re-transplantation, or the need for coronary revascularization in the long-term period after orthotopic heart transplantation (HT).

Methods: All recipients who received the heart transplant at the Shumakov National Transplant Centre (Moscow, Russia) between January 2013 and December 2016 and survived 30 days after the surgery were included. Initial endomyocardial biopsy and coronary angiography were performed at the first week. Patients with >50% stenosis in the large branches of the coronary arteries were randomized to receive immediate PTCA or not. All-cause death, re-transplantation due to irreversible heart graft dysfunction, and the need for PTCA were used as a primary outcome composite endpoint.

Results: A total of 431 HT were performed from 15.01.2013 to 29.12.2016; 389 (90.3%) patients have survived 30 days after HT; 10 (2.3%) patients who underwent repeated HT within 30 days were not included in the study. The primary coronary angiography revealed single or multiple stenoses <50% in 25 (6.6%) pts; 56 (14.9%) pts had significant >50% coronary stenosis, among them 24 random patients had the stent PTCA. During the follow-up period of 2112.1±146.0 (95% CI: 2022-2587) days, 42 (11.1%) patients died, the re-transplantation was performed in 9 (2.4%) cases, and PTCA was required in 61 (16.1%) cases. A Kaplan-Meier comparison showed a similar event-free survival rate in patients without initial changes in the coronary arteries, patients with <50% stenosis, and patients with >50% stenosis who underwent preventive PTCA, which was significantly better than had patients with >50% stenosis who did not undergo PTCA.

Conclusion: The study showed that the presence of the occlusive (>50%) stenotic coronary segments in the donor’s heart has significant effect on event-free survival after HT and preventive PTCA of these segments improves the risk of death and re-transplantation while increases the likelihood of repeated coronary revascularization in the future.

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