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Percutaneous coronary intervention with stent deployment for the treatment of graft vasculopathy after cardiac trasnplantation-a single center experience
S168
Abstracts
The Journal of Heart and Lung Transplantation February 2005
Methods: We identified a cohort of 12 patients in our CT clinic with either adverse events related to statin therapy necessitating discontinuation of this class of medication (n⫽6) or refractorylipids despite maximal doses of a statin (n⫽6). Baseline lipid profiles were obtained in both groups prior to instituting therapy with ezetimibe at a dose of 10 mg/day. There was no washout period. Serum lipids, transaminases and creatine kinase were periodically measured thereafter. Results: Median follow-up in the cohort with refractory lipids was 4 months and in the group with adverse events on statins was 3 months. Median change in lipid parameters for the 2 groups is shown below.
Median Change in Lipid Parameters (mmol/liter) from Baseline Ezetimibe ⫹ Statin Ezetimibe Alone
TC
LDL
HDL
TG
21.12 (IQR 0.49) 10.70 (IQR 1.33)
20.90 (IQR 0.23) 10.46 (IQR 1.32)
20.01 (IQR 0.23) 10.05 (IQR 0.21)
20.76 (IQR 1.45) 10.65 (IQR 0.37)
IQR ⫽ Interquartile Range
There was no difference in serum transaminase and creatine kinase levels in either group from baseline through the follow-up period. Conclusions: Ezetimibe may be used safely in CT recipients. In patients with refractory lipids post-transplant, the addition of ezetimibe 10 mg/day to a statin results in incremental improvement of TC, LDL and triglycerides. Based on these early results, we continue to enroll patients in this study.
386 PERCUTANEOUS CORONARY INTERVENTION WITH STENT DEPLOYMENT FOR THE TREATMENT OF GRAFT VASCULOPATHY AFTER CARDIAC TRASNPLANTATION-A SINGLE CENTER EXPERIENCE B. Sheick-Yousif,1 J. Lavee,1 Y. Har Zahav,2 1Heart Transplantation Unit, Dept. of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2Heart Institute, Sheba Medical Center, Tel Hashomer, Israel Objective: Retrospective review of our total experience with percutaneous coronary interventions (PCI) for graft vasculopathy after heart transplantation. Patient and methods: During a 14-year period follow up (June 1991 to February 2004) 20 pts out of 150 pts who underwent heart transplantation (18 males, 2 females) underwent PCI. Age range was 39 –73 years (mean 57). The indication for transplantation was ischemic cardiomyopathy in 15 pts (75%). The interval from transplant to initial intervention was 0.4 to 12 years (mean 6 years). Four pts died during the follow up period. Results: Overall 43 PCIs were performed in these 20 pts: PTCA only in 6 pts and PTCA with stent deployment in 37 pts. The target coronary arteries for PCI were LAD in 21 pts (49%), RCA in 10 (23%), Cx in 10 (23%), LPDA in 1 (2.5%) and diagonal in one patient (2.5%). In the PTCA only treated vessels a 50% restenosis rate was observed at the last angiographic examination. In the stent treated vessels the periprocedural success was 100%. Stent patency rate, defined as ⬍50% in-stent restenosis, was 93% (0.049 SE) after 12 months and 68% (0.107 SE) after 60 months. The Kaplan Meier analysis for stent patency rate is depicted in the Figure below. Conclusion: PTCA with stent deployment to treat graft vasculopathy in patients after cardiac transplantation provides a good and viable solution for these patients.
387 VALIDATION OF ALGORITHM FOR DIAGNOSIS AND TREATMENT OF CYTOMEGALOVIRUS (CMV) INFECTION IN HEART TRANSPLANT RECIPIENTS BASED OF pp65 ANTIGENAEMIA BY QUANTITATIVE POLYMERASE CHAIN REACTION (PCR) M.W. Zakliczynski,1 S. Dworniczak,1 U. Mazurek,1 M. Zembala,1 1 Dept. of Transplantation, Silesian Ctr for Ht Dis, Zabrze, Poland Our earlier analyses revealed that pp65 antigenaemia correlated very well with clinical signs of CMV infection, and decision to terminate gancyclovir administration based on elimination of pp65-postive leucocytes was appropriate in 90% of cases. However, in a number of pts. relapse of CMV was observed after quick (2 week) cessation of gancyclovir treatment, despite negative pp65 result (10%), and it was necessary to repeat pp65 study in 9% of pts. with evident CMV signs to achieve a positive result. The aim of this study was to assess a possibility that quantitative PCR may have an additive value for earlier diagnosis of CMV infection, and/or indication of the treatment termination moment. Material and methods: From the group of 146 pts. with routine pp65-antigen evaluation , 53 individuals were randomly selected, in whom additional quantitative PCR measurement of CMV genome in leucocytes was performed. pp65 results were expressed as a number of pp65-postive cells per 200 000 leucocytes, while PCR results were presented as number of CMV DNA copies per 1 million of cells. The overall number of paired samples was 128. Results: Positive pp65 result was found in 38 cases: number of pp65-positive cells was 1–700 (median 8); number of CMV DNA copies was 38 – 43853 (median 859). In 90 cases of pp65-negative result number of CMV DNA copies was 0 –9647 (median 448). There was a significant correlation between pp65-positive cells and CMV DNA copies (r⫽0.66, Pearson). There was no difference in a number of CMV DNA copies between patients with pp65-negative result in whom CMV-disease developed vs. without CMV–25–2658 (median 223) vs. 0 –9647 (median 380); and between patients in whom gancyclovir therapy was stopped too quickly vs. without CMV relapse–3–2524 (median 389) vs. 108 – 8550 (median 705). Conclusion: Quantitative PCR correlates with pp65 antigenaemia, however, it has no additional value for diagnosis of CMV disease or planning of gancyclovir therapy duration. 388 SUCCESSFUL OUTCOME FOLLOWING LUNG TRANSPLANTION FOR RECIPIENTS COLONISED WITH FILAMENTOUS FUNGI AT TIME OF TRANSPLANT
Abstracts
The Journal of Heart and Lung Transplantation February 2005
Methods: We identified a cohort of 12 patients in our CT clinic with either adverse events related to statin therapy necessitating discontinuation of this class of medication (n⫽6) or refractorylipids despite maximal doses of a statin (n⫽6). Baseline lipid profiles were obtained in both groups prior to instituting therapy with ezetimibe at a dose of 10 mg/day. There was no washout period. Serum lipids, transaminases and creatine kinase were periodically measured thereafter. Results: Median follow-up in the cohort with refractory lipids was 4 months and in the group with adverse events on statins was 3 months. Median change in lipid parameters for the 2 groups is shown below.
Median Change in Lipid Parameters (mmol/liter) from Baseline Ezetimibe ⫹ Statin Ezetimibe Alone
TC
LDL
HDL
TG
21.12 (IQR 0.49) 10.70 (IQR 1.33)
20.90 (IQR 0.23) 10.46 (IQR 1.32)
20.01 (IQR 0.23) 10.05 (IQR 0.21)
20.76 (IQR 1.45) 10.65 (IQR 0.37)
IQR ⫽ Interquartile Range
There was no difference in serum transaminase and creatine kinase levels in either group from baseline through the follow-up period. Conclusions: Ezetimibe may be used safely in CT recipients. In patients with refractory lipids post-transplant, the addition of ezetimibe 10 mg/day to a statin results in incremental improvement of TC, LDL and triglycerides. Based on these early results, we continue to enroll patients in this study.
386 PERCUTANEOUS CORONARY INTERVENTION WITH STENT DEPLOYMENT FOR THE TREATMENT OF GRAFT VASCULOPATHY AFTER CARDIAC TRASNPLANTATION-A SINGLE CENTER EXPERIENCE B. Sheick-Yousif,1 J. Lavee,1 Y. Har Zahav,2 1Heart Transplantation Unit, Dept. of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2Heart Institute, Sheba Medical Center, Tel Hashomer, Israel Objective: Retrospective review of our total experience with percutaneous coronary interventions (PCI) for graft vasculopathy after heart transplantation. Patient and methods: During a 14-year period follow up (June 1991 to February 2004) 20 pts out of 150 pts who underwent heart transplantation (18 males, 2 females) underwent PCI. Age range was 39 –73 years (mean 57). The indication for transplantation was ischemic cardiomyopathy in 15 pts (75%). The interval from transplant to initial intervention was 0.4 to 12 years (mean 6 years). Four pts died during the follow up period. Results: Overall 43 PCIs were performed in these 20 pts: PTCA only in 6 pts and PTCA with stent deployment in 37 pts. The target coronary arteries for PCI were LAD in 21 pts (49%), RCA in 10 (23%), Cx in 10 (23%), LPDA in 1 (2.5%) and diagonal in one patient (2.5%). In the PTCA only treated vessels a 50% restenosis rate was observed at the last angiographic examination. In the stent treated vessels the periprocedural success was 100%. Stent patency rate, defined as ⬍50% in-stent restenosis, was 93% (0.049 SE) after 12 months and 68% (0.107 SE) after 60 months. The Kaplan Meier analysis for stent patency rate is depicted in the Figure below. Conclusion: PTCA with stent deployment to treat graft vasculopathy in patients after cardiac transplantation provides a good and viable solution for these patients.
387 VALIDATION OF ALGORITHM FOR DIAGNOSIS AND TREATMENT OF CYTOMEGALOVIRUS (CMV) INFECTION IN HEART TRANSPLANT RECIPIENTS BASED OF pp65 ANTIGENAEMIA BY QUANTITATIVE POLYMERASE CHAIN REACTION (PCR) M.W. Zakliczynski,1 S. Dworniczak,1 U. Mazurek,1 M. Zembala,1 1 Dept. of Transplantation, Silesian Ctr for Ht Dis, Zabrze, Poland Our earlier analyses revealed that pp65 antigenaemia correlated very well with clinical signs of CMV infection, and decision to terminate gancyclovir administration based on elimination of pp65-postive leucocytes was appropriate in 90% of cases. However, in a number of pts. relapse of CMV was observed after quick (2 week) cessation of gancyclovir treatment, despite negative pp65 result (10%), and it was necessary to repeat pp65 study in 9% of pts. with evident CMV signs to achieve a positive result. The aim of this study was to assess a possibility that quantitative PCR may have an additive value for earlier diagnosis of CMV infection, and/or indication of the treatment termination moment. Material and methods: From the group of 146 pts. with routine pp65-antigen evaluation , 53 individuals were randomly selected, in whom additional quantitative PCR measurement of CMV genome in leucocytes was performed. pp65 results were expressed as a number of pp65-postive cells per 200 000 leucocytes, while PCR results were presented as number of CMV DNA copies per 1 million of cells. The overall number of paired samples was 128. Results: Positive pp65 result was found in 38 cases: number of pp65-positive cells was 1–700 (median 8); number of CMV DNA copies was 38 – 43853 (median 859). In 90 cases of pp65-negative result number of CMV DNA copies was 0 –9647 (median 448). There was a significant correlation between pp65-positive cells and CMV DNA copies (r⫽0.66, Pearson). There was no difference in a number of CMV DNA copies between patients with pp65-negative result in whom CMV-disease developed vs. without CMV–25–2658 (median 223) vs. 0 –9647 (median 380); and between patients in whom gancyclovir therapy was stopped too quickly vs. without CMV relapse–3–2524 (median 389) vs. 108 – 8550 (median 705). Conclusion: Quantitative PCR correlates with pp65 antigenaemia, however, it has no additional value for diagnosis of CMV disease or planning of gancyclovir therapy duration. 388 SUCCESSFUL OUTCOME FOLLOWING LUNG TRANSPLANTION FOR RECIPIENTS COLONISED WITH FILAMENTOUS FUNGI AT TIME OF TRANSPLANT