Akademik Veri Yönetim Sistemi
19th International Congress of Update in Cardiology and Cardiovascular Surgery, İstanbul, Türkiye, 4 - 06 Kasım 2023, cilt.11, sa.30620392, ss.149-150, (Tam Metin Bildiri)
Coronary Artery Bypass Grafting After PCI in A Heart Transplant Patient
MD Barış Avşar* , MD Alperen İşeri , Prof. Sema Güneri , Prof. Öztekin Oto Dokuz Eylül University, İzmir, Turkey
OBJECTİVE:The patient, who had a heart transplant 24 years ago, had CABG surgery due to transplant coronary artery disease (TCAD), which occurred last year. We defend the superiority of LIMA-LAD bypass over stent based on the patient who underwent PCI 8 months before CABG.
METHODS: A 44-year-old man, who had undergone orthotopic heart transplantation for dilated cardiomyopathy in 1999, 23 years after the transplant, he applied to another university hospital with back and headache. LAD PCI was applied to the patient who underwent CPR after cardiac arrest. CABG was planned for the patient who applied to us with ongoing back pain 8 months after coronary angiography, as severe stenosis was detected in the LAD in-stent and RCA in the control coronary angiography. (A) LAD %80 stenosis in stent (B) Non-dominant RCA proximal long segment %80 stenosis (C) LIMA-LAD anastomosis (D) Peripheral cannulation and median sternotomy We performed peripheral cannulation and CPB was initiated, then the heart was exposed again through median sternotomy. LIMA was prepared as a graft. All adhesions surrounding the heart were dissected, exposing the aorta, right atrium, LAD, and RCA. The LAD was carefully examined and digitally palpated. The pericardial fat surrounding the vessel was tense and accumulated in an inflammatory reaction, but there was no calcium deposition. Since the RCA was non-dominant and thin, it was not suitable for bypass. LIMA was anastomosed to the LAD without any problems.
RESULTS: No complications developed. 650 cc of drainage occurred in the first 24 hours post-op. The patient, who was in good hemodynamic condition, was extubated at the 9th postoperative hour. After surgery, the patient's symptoms disappeared. His preoperative immunosuppressive regimen included tacrolimus 1 mg twice a day, mycophenolate mofetil 2000 mg once a day. Postoperatively, 4 mg twice a day Methylprednisolone treatment was added.
CONCLUSIONS: PCI in patients with TCAV has been associated with greater restenosis rates compared to PCI in patients with native CAD1. It has been shown that both CABG and PCI are feasible methods for revascularization in TCAV patients, with PCI being associated with lower mortality and no difference in cardiac mortality during the same follow-up period 2. PTCA reportedly has been performed in 1.8% to 4.7% of patients with TCAD.3,5 The primary angiographic success rate has been reported to be excellent, ranging from 84% to 100%, but the restenosis rate within a year is significant (42% to 67%)3,4,5. We think that CABG is superior to PCI in patients with Transplant coronary artery disease (TCAD). We believe that the LAD-LIMA anastomosis will provide longer clearance than the stent. Further studies are needed to delineate evidence-based guidelines to tailor the appropriate therapy, CABG or PCI, to the appropriate patient with TCAV.
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