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Serrao G, Vinayak M, Nicolas J, Subramaniam V, Lai AC, Laskey D, Kini A, Seethamraju H, Scheinin S. The Evaluation and Management of Coronary Artery Disease in the Lung Transplant Patient. J Clin Med 2023; 12:7644. [PMID: 38137713 PMCID: PMC10743826 DOI: 10.3390/jcm12247644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Lung transplantation can greatly improve quality of life and extend survival in those with end-stage lung disease. In order to derive the maximal benefit from such a procedure, patients must be carefully selected and be otherwise healthy enough to survive a high-risk surgery and sometimes prolonged immunosuppressive therapy following surgery. Patients therefore must be critically assessed prior to being listed for transplantation with close attention paid towards assessment of cardiovascular health and operative risk. One of the biggest dictators of this is coronary artery disease. In this review article, we discuss the assessment and management of coronary artery disease in the potential lung transplant candidate.
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Affiliation(s)
- Gregory Serrao
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.V.); (J.N.); (V.S.); (A.C.L.); (D.L.); (A.K.); (H.S.); (S.S.)
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2
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Routine Coronary Angiography is Still the Key Test for Patients Eligible for Lung Transplantation Also for Those With No Symptoms and With High Risk of Coronary Artery Disease. Transplant Proc 2022; 54:1074-1077. [DOI: 10.1016/j.transproceed.2022.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
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3
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Sinha N, Balayla G, Braghiroli J. Coronary artery disease in lung transplant patients. Clin Transplant 2020; 34:e14078. [PMID: 32940380 DOI: 10.1111/ctr.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 01/11/2023]
Abstract
Coronary artery disease (CAD) is a pathology often found in patients with end-stage lung disease. Although in the past CAD might have been considered an absolute contraindication, modern revascularization techniques have helped increase the number of transplants performed in this population. However, discrepancies in the guidelines for perioperative evaluation and risk mitigation strategies for the ischemic cardiac burden are present in the current literature. This is a review of the available data regarding perioperative evaluation, revascularization tactics, postoperative management, and survival rate that patients with different grades of coronary artery disease present after lung transplantation.
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Affiliation(s)
- Neeraj Sinha
- Division of Pulmonary and Critical Care Medicine, Transplant Pulmonology, University of Miami, Miami, FL, USA
| | - Galit Balayla
- Department of General Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Joao Braghiroli
- Division of Interventional Cardiology, Jackson Health System, Miami, FL, USA
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4
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William S R, Nilto C DO, Richard C, Keith M, James D M. Long-Term Impact of Coronary Artery Disease in Lung Transplantation. ACTA ACUST UNITED AC 2019. [DOI: 10.29328/journal.jccm.1001073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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5
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Makey IA, Sui JW, Huynh C, Das NA, Thomas M, Johnson S. Lung transplant patients with coronary artery disease rarely die of cardiac causes. Clin Transplant 2018; 32:e13354. [DOI: 10.1111/ctr.13354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Ian A. Makey
- Department of Cardiothoracic Surgery Mayo Clinic; Jacksonville Florida
| | - Jin W. Sui
- Long School of Medicine, University of Texas Health San Antonio; San Antonio Texas
| | - Charles Huynh
- Long School of Medicine, University of Texas Health San Antonio; San Antonio Texas
| | - Nitin A. Das
- Department of Cardiothoracic Surgery; University of Texas Health, San Antonio Texas
| | - Mathew Thomas
- Department of Cardiothoracic Surgery Mayo Clinic; Jacksonville Florida
| | - Scott Johnson
- Department of Cardiothoracic Surgery; University of Texas Health, San Antonio Texas
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6
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Khandhar SJ, Althouse AD, Mulukutla S, Kormos R, Toma C, Marroquin O, Volz E, Tefera L, Bermudez C. Postoperative outcomes and management strategies for coronary artery disease in patients in need of a lung transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sameer J. Khandhar
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | | | | | - Robert Kormos
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Catalin Toma
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | | | - Elizabeth Volz
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Leben Tefera
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Christian Bermudez
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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7
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How important is coronary artery disease when considering lung transplant candidates? J Heart Lung Transplant 2016; 35:1453-1461. [DOI: 10.1016/j.healun.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 03/01/2016] [Accepted: 03/27/2016] [Indexed: 12/30/2022] Open
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8
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McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH. Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant. J Heart Lung Transplant 2016; 35:1289-1294. [PMID: 27381675 DOI: 10.1016/j.healun.2016.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 04/18/2016] [Accepted: 05/30/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prior coronary artery bypass grafting (CABG) has been a contraindication to lung transplantation (LTx) because of disease severity and technical considerations. Although patients increasingly are being referred for and receiving LTx, whether it should remain a contraindication is unknown. We sought to define the prevalence of LTx after CABG and determine the effect on outcomes. METHODS The United Network for Organ Sharing Standard Transplant Analysis and Research data set was queried during the period 2004-2013 for adult LTx patients, as prior CABG became a mandatory reporting field in 2004. The primary end-points were 30-day and 1-, 3-, and 5-year survivals. RESULTS The study cohort included 14,791 patients, of whom 292 patients had previously undergone CABG (single left, n = 68; single right, n = 181; bilateral, n = 43), representing 2% of all transplants. For the entire cohort, 30-day survival was 97%, and survival at 1, 3, and 5 years was 88%, 79%, and 74%. CABG was a predictor of mortality at all time points, with hazard ratios ranging from 1.97 (confidence interval, 1.23-3.16; p < 0.01) at 30 days to 1.38 (confidence interval, 1.12-1.69; p < 0.01) at 5 years. When stratified by type of transplant, CABG strongly predicted mortality at all time points for patients receiving bilateral, but not single, transplants. CONCLUSIONS Although LTx after CABG is uncommon, it is increasingly performed in the current era. Single right LTx is the most common procedure performed in patients with prior CABG. CABG before LTx is an independent predictor of mortality at all time points and is driven by increased mortality in patients receiving bilateral LTx.
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Affiliation(s)
- Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Megan E Bowen
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Bradley C Baird
- Division of Business/Computer Information Systems, Arizona Western College, Yuma, Arizona
| | - Sanjeev Raman
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbara C Cahill
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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9
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Biniwale R, Ross D, Iyengar A, Kwon OJ, Hunter C, Aboulhosn J, Gjertson D, Ardehali A. Lung transplantation and concomitant cardiac surgery: Is it justified? J Thorac Cardiovasc Surg 2016; 151:560-6. [DOI: 10.1016/j.jtcvs.2015.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/05/2015] [Accepted: 10/01/2015] [Indexed: 01/24/2023]
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10
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Chaikriangkrai K, Jyothula S, Jhun HY, Estep J, Loebe M, Scheinin S, Torre-Amione G. Impact of pre-operative coronary artery disease on cardiovascular events following lung transplantation. J Heart Lung Transplant 2016; 35:115-121. [DOI: 10.1016/j.healun.2015.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/04/2015] [Accepted: 08/22/2015] [Indexed: 11/27/2022] Open
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11
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Budev MM, Yun JJ. Medical complications after lung transplantation. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Prevalence of asymptomatic coronary disease in fibrosing idiopathic interstitial pneumonias. Eur J Radiol 2015; 84:163-171. [DOI: 10.1016/j.ejrad.2014.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 12/17/2022]
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13
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Manoushagian S, Meshkov A. Evaluation of solid organ transplant candidates for coronary artery disease. Am J Transplant 2014; 14:2228-34. [PMID: 25220486 DOI: 10.1111/ajt.12915] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/30/2014] [Accepted: 06/29/2014] [Indexed: 01/25/2023]
Abstract
Solid organ transplantation has increased in frequency in the United States, having evolved from an area of experimentation into accepted therapy for end-organ failure. As organ transplantation has become more common, the average age of transplant recipients has increased, thus increasing the potential for multiple comorbidities including coronary artery disease (CAD). CAD has been shown to be a major cause of morbidity and mortality in kidney, lung and liver transplant recipients. Identification of CAD in solid organ transplant candidates allows for stratification of short- and long-term risk, ensuring proper use of valuable allograft resources while guiding further patient management. Assessment of asymptomatic transplant candidates for CAD is difficult. Many patients undergo stress echocardiography or nuclear imaging, which have demonstrated inconsistent rates of sensitivity and specificity for the detection of CAD in these patient populations. Cardiac computed tomography is a potential tool for detecting CAD in these populations, but has questionable utility at this time. Coronary angiography has an important role in detecting CAD in high-risk transplant candidates, affecting their long-term management and risk.
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Affiliation(s)
- S Manoushagian
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
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14
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Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation. Transplantation 2014; 97:1079-85. [PMID: 24646771 DOI: 10.1097/01.tp.0000438619.96933.02] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined. METHODS All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization. RESULTS Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411). CONCLUSIONS Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity.
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15
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Picard C, Roux A. [Contraindications to lung transplantation: evolving limits?]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:156-163. [PMID: 24932503 DOI: 10.1016/j.pneumo.2013.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
In France, the higher frequency of pulmonary sample in organ donors and the enhancement of surgical and perioperative life support techniques, have increased the number procedures and the short term prognosis of lung transplantation (LT). In this setting, the classical contraindications of LT need to be reconsidered. In this article, some of the classical contraindication of LT are confronted to the experience acquired in other solid organ transplantations or from some LT centers. Specific situations such as LT in patients with previous cancer, HIV infection, viral hepatitis, nutritional disorders, acutely ill LT candidates and aging candidates are addressed. Surgical contraindications are not reviewed.
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Affiliation(s)
- C Picard
- Service de pneumologie et de transplantation pulmonaire, groupe de transplantation pulmonaire, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - A Roux
- Service de pneumologie et de transplantation pulmonaire, groupe de transplantation pulmonaire, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
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16
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Abstract
Since the first successful lung transplant 30 years ago, lung transplantation has rapidly become an established standard of care to treat end-stage lung disease in selected patients. Advances in lung preservation, surgical technique, and immunosuppression regimens have resulted in the routine performance of lung transplantation around the world for an increasing number of patients, with wider indications. Despite this, donor shortages and chronic lung allograft dysfunction continue to prevent lung transplantation from reaching its full potential. With research into the underlying mechanisms of acute and chronic lung graft dysfunction and advances in personalized diagnostic and therapeutic approaches to both the donor lung and the lung transplant recipient, there is increasing confidence that we will improve short- and long-term outcomes in the near future.
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Affiliation(s)
- Jonathan C Yeung
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario M5G 2C4, Canada
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17
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Jones RM, Enfield KB, Mehrad B, Keeley EC. Prevalence of obstructive coronary artery disease in patients undergoing lung transplantation: case series and review of the literature. Catheter Cardiovasc Interv 2013; 84:1-6. [PMID: 24136925 DOI: 10.1002/ccd.25261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/14/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Coronary angiography is commonly performed prior to lung transplantation, but its utility is unproven. METHODS We conducted a single-center retrospective analysis of consecutive patients referred for coronary angiography as part of a pre-operative evaluation for lung transplantation and reviewed the literature for prior series. RESULTS A total of 89 patients, 48 men and 41 women were included. Obstructive (≥70% stenosis) CAD was present in 9 (10%), non-obstructive (<70% stenosis) CAD in 24 (27%), and no angiographic evidence of CAD in 56 (63%) patients. We found 13 previously published series in the literature, in which a total of 1998 patients underwent coronary angiography pre-lung transplant. Together with our 89 patients, obstructive CAD was found in 11%. CONCLUSIONS In conclusion, given the low prevalence of obstructive CAD in patients referred for lung transplantation, the inherent risk of angiography, and unproven benefit of detection of obstructive CAD, the utility of routine coronary angiography in this population requires validation in prospective studies.
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Affiliation(s)
- Robert M Jones
- Department of Medicine, University of Virginia, Charlottesville, Virginia
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18
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Castleberry AW, Martin JT, Osho AA, Hartwig MG, Hashmi ZA, Zanotti G, Shaw LK, Williams JB, Lin SS, Davis RD. Coronary revascularization in lung transplant recipients with concomitant coronary artery disease. Am J Transplant 2013; 13:2978-88. [PMID: 24102830 PMCID: PMC4332513 DOI: 10.1111/ajt.12435] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 07/16/2013] [Accepted: 07/20/2013] [Indexed: 01/25/2023]
Abstract
Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible.
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Affiliation(s)
- A. W. Castleberry
- Department of Surgery, Duke University Medical Center, Durham, NC,Corresponding author: Anthony W. Castleberry,
| | - J. T. Martin
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY
| | - A. A. Osho
- Duke University School of Medicine, Durham, NC
| | - M. G. Hartwig
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Z. A. Hashmi
- Division of Cardiothoracic Surgery, Indiana University Health, Indianapolis, IN
| | - G. Zanotti
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - L. K. Shaw
- Duke Clinical Research Institute, Durham, NC
| | - J. B. Williams
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC,Duke Clinical Research Institute, Durham, NC
| | - S. S. Lin
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC,Department of Immunology and Department of Pathology, Duke University Medical Center, Durham, NC
| | - R. D. Davis
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
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19
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Sherman W, Rabkin DG, Ross D, Saggar R, Lynch JP, Belperio J, Saggar R, Hamilton M, Ardehali A. Lung transplantation and coronary artery disease. Ann Thorac Surg 2011; 92:303-8. [PMID: 21718862 DOI: 10.1016/j.athoracsur.2011.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 03/31/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) remains a relative contraindication to lung transplantation. We have offered lung transplantation and coronary revascularization to selected patients with discrete CAD and preserved left ventricular function. The purpose of this report is the following: (1) to examine the short-term and medium-term outcome of patients after coronary revascularization and lung transplantation; and (2) to compare the short-term and medium-term outcome of this cohort to a matched group of lung transplant recipients without CAD. METHODS From January 2000 to March 2010, 27 patients with CAD underwent coronary revascularization and lung transplantation. The control group was matched based on age, diagnosis, lung allocation score, and type of procedure. RESULTS Lung transplant recipients with CAD and the control group had similar incidence of primary graft dysfunction (grade III). The duration of mechanical ventilation, intensive care unit stay, and hospital stay were the same. At a mean follow-up of 3 years, the incidence of composite adverse cardiac events was similar in the 2 groups. CONCLUSIONS Lung transplant recipients with CAD and the control group also had similar medium-term survival. Lung transplantation can be considered in patients with preexistent CAD with acceptable early and medium-term outcomes.
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Affiliation(s)
- William Sherman
- Division of Cardiothoracic Surgery, Department of Surgery, Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095, USA
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20
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Rama-Maceiras P, Díaz-Allegue M, Pato-López O, Ramos-López L, Rey-Rilo T, Bonome-González C. [Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:425-430. [PMID: 20857638 DOI: 10.1016/s0034-9356(10)70269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.
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Affiliation(s)
- P Rama-Maceiras
- Servicio de Anestesiología y Reanimación. Complejo Hospitalario Universitario. A Coruña.
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21
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Choong CK, Meyers BF, Guthrie TJ, Trulock EP, Patterson GA, Moazami N. Does the presence of preoperative mild or moderate coronary artery disease affect the outcomes of lung transplantation? Ann Thorac Surg 2006; 82:1038-42. [PMID: 16928531 DOI: 10.1016/j.athoracsur.2006.03.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 03/10/2006] [Accepted: 03/15/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Significant coronary artery disease (CAD) is an exclusion criterion for lung transplantation at most centers. However, the impact of preoperative noncritical CAD (single or multivessel mild <30% or moderate 30% to 50% stenosis) on the outcomes of lung transplantation is unknown. METHODS A retrospective review of 268 adult patients who underwent lung transplantation between June 1998 and June 2003 at Barnes-Jewish Hospital, a tertiary care center affiliated with Washington University School of Medicine, was performed. RESULTS Two hundred ten patients had coronary angiography performed as part of their pretransplantation evaluation. Among these patients, 177 patients had no CAD, and 33 patients (mild, 16; moderate, 17) had noncritical CAD. Patients with noncritical CAD were older (59 versus 55 years, p < 0.001) and had a higher prevalence of diabetes (24% versus 9%, p = 0.014) and systemic hypertension (58% versus 36%, p = 0.004) than patients without CAD. There was no significant difference in the underlying lung disease, other comorbidities, type of lung transplantation performed, early postoperative complications, and hospital or late mortality between recipients with or without CAD. Among the patients with noncritical CAD, there was no hospital mortality and no late cardiac mortality. Three recipients with preoperative moderate CAD developed late ischemic cardiac events, and revascularization was performed in 2 of these recipients. Long-term survival was similar among recipients with or without preoperative CAD. CONCLUSIONS Preoperative noncritical (mild or moderate) CAD was not associated with increased perioperative morbidity or mortality, and it did not adversely affect short-term or long-term survival. Late ischemic events developed in 18% of the recipients with moderate CAD disease with no effect on mortality.
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Affiliation(s)
- Cliff K Choong
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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22
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Abstract
The lung is an anatomically complex vital organ whose normal physiology depends on actively regulated ventilation and perfusion, and maintenance of a delicate blood-air barrier over a huge surface area in direct contact with a potentially hostile environment. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung recipients relative to other "solid" organs. This review summarizes the current status of lung transplantation so as to frame the principle challenges currently facing end-stage lung-failure patients and the practitioners who care for them.
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Affiliation(s)
- Richard N Pierson
- Division of Cardiac Surgery, Department of Surgery, University of Maryland and Baltimore VAMC, Baltimore, MD, USA.
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23
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Barr ML, Kawut SM, Whelan TP, Girgis R, Böttcher H, Sonett J, Vigneswaran W, Follette DM, Corris PA. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part IV: Recipient-Related Risk Factors and Markers. J Heart Lung Transplant 2005; 24:1468-82. [PMID: 16210118 DOI: 10.1016/j.healun.2005.02.019] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 02/07/2005] [Accepted: 02/17/2005] [Indexed: 12/27/2022] Open
Affiliation(s)
- Mark L Barr
- University of Southern California, Los Angeles, California 90033, USA.
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Ben-Dor I, Shitrit D, Kramer MR, Iakobishvili Z, Sahar G, Hasdai D. Is Routine Coronary Angiography and Revascularization Indicated Among Patients Undergoing Evaluation for Lung Transplantation? Chest 2005; 128:2557-62. [PMID: 16236923 DOI: 10.1378/chest.128.4.2557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To review coronary artery disease (CAD) prevalence among lung transplantation (LTx) candidates, the time interval from coronary angiography (CA) to LTx/death, and post-revascularization outcomes. BACKGROUND CA is advised for LTx candidates because significant CAD is a contraindication for LTx. METHODS We monitored all LTx candidates from 1997 who underwent CA. Significant CAD was defined as stenosis > or = 70% in diameter. RESULTS Of 118 candidates > 40 years old (68.3% men; median age, 58 years; 25 to 75th interquartiles, 53 to 61 years), 59 patients underwent LTx, 56 patients were eligible for LTx, and 3 patients were excluded due to CAD. Significant CAD was detected in 21 patients (17.8%), nonsignificant CAD was found in 21 patients (17.8%), and no CAD was found in 76 patients (64.4%), without significant differences in the demographic/clinical profile among patients with or without significant CAD. Among 21 patients with significant CAD, 12 patients (57.1%) underwent successful percutaneous coronary intervention (PCI), 1 patient had failed to respond to PCI, and 8 patients (38.1%) had no intervention. After PCI, one patient had periprocedural infarction, one patient had stent thrombosis, and one patient had symptomatic restenosis. The median time interval CA to LTx/death/last visit among the 115 candidates was 166 days (interquartiles, 48 to 410 days). Death occurred before LTx in 30 patients (53.5%) during a follow-up of 312 days (interquartiles, 46 to 664 days) and after LTx in 14 patients (23.7%) during a follow-up of 142 days (interquartiles, 73 to 304 days), without any difference in outcome based on severity of CAD in the two groups (p = 0.7 and p = 0.6, respectively). CONCLUSIONS CAD prevalence among LTx candidates is low and cannot be accurately predicted by risk factors. Revascularization may be associated with complications, and the time interval between revascularization and LTx may be long. Conversely, certain patients with significant CAD underwent LTx without complications. The practice of routine CA and revascularization prior to LTx should be reconsidered, and perhaps reserved for selected patients with high-risk features.
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Affiliation(s)
- Itsik Ben-Dor
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, Israel 49100
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Parekh K, Meyers BF, Patterson GA, Guthrie TJ, Trulock EP, Damiano RJ, Moazami N. Outcome of lung transplantation for patients requiring concomitant cardiac surgery. J Thorac Cardiovasc Surg 2005; 130:859-63. [PMID: 16153940 DOI: 10.1016/j.jtcvs.2005.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 05/02/2005] [Accepted: 05/09/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical results of lung transplantation and concomitant cardiac surgery are unclear. The effect of cardiopulmonary bypass on the pulmonary allograft is controversial, and the effect of cardiac arrest and cardiac surgery in this setting is unknown. Our aim was to review the operative results and long-term survival in this group of patients. METHODS A retrospective review of all lung transplantations between 1988 and 2003 was performed. Patients who had concomitant cardiac surgery during lung transplantation were compared with those who underwent lung transplantation alone. The variables analyzed included allograft ischemic times, use of cardiopulmonary bypass, early graft dysfunction, postoperative morbidity, survival, length of mechanical ventilation, length of stay in the intensive care unit, and overall hospital stay. RESULTS During this period, 35 of 700 lung transplant recipients (15 single and 20 bilateral transplantations) underwent concomitant cardiac surgery. The cardiac procedures were for patent foramen ovale (n = 18), atrial septal defect (n = 9), ventricular septal defect (n = 2), coronary bypass (n = 4), and "other" (n = 2). Allograft ischemic time, use of extracorporeal membrane oxygenation, length of hospital stay, operative mortality, and survival were not significantly different between the 2 groups. Ventilator time and intensive care unit stay were longer in the cardiac surgery group. CONCLUSIONS Cardiac surgery at the time of lung transplantation can be performed with acceptable morbidity and mortality. The immediate and long-term survival in these patients is similar to that of other lung transplant recipients. Lung transplantation should continue to be offered to patients with normal ventricular function who require concomitant limited cardiac surgery.
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Affiliation(s)
- Kalpaj Parekh
- University of Iowa Hospital and Clinics, Resident Department of Cardiothoracic Surgery, Iowa City, Iowa, USA
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Abstract
PURPOSE OF REVIEW Interstitial lung disease includes a heterogeneous group of disorders that leads to respiratory insufficiency and death in a significant number of patients. Lung transplantation is a therapeutic option in select candidates. RECENT FINDINGS The indications, transplant procedure options, and outcomes continue to evolve. Various recipient comorbidities influence the choice of procedure in patients with interstitial lung disease. Single lung transplants are used as the procedure of choice and bilateral transplants are reserved for patients with suppurative lung disease and patients with pulmonary hypertension. Issues unique to patients with interstitial lung disease affect the morbidity, mortality and recurrence of the disease. SUMMARY Lung transplantation is an effective therapy for respiratory failure in interstitial lung disease with survival following transplant being similar to that achieved in transplant recipients with other diseases.
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Affiliation(s)
- Raed Alalawi
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Seoane L, Arcement LM, Valentine VG, McFadden PM. Long-term survival in lung transplant recipients after successful preoperative coronary revascularization. J Thorac Cardiovasc Surg 2005; 130:538-41. [PMID: 16077424 DOI: 10.1016/j.jtcvs.2004.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Coronary artery disease is considered a contraindication to lung transplantation. We studied effect of pre-lung transplantation nonobstructive coronary artery disease and revascularized coronary artery disease on long-term lung transplant survival. METHODS Clinical courses of 172 lung transplant recipients from December 1990 to May 2003 were reviewed. Significant coronary artery disease, defined as left main stenosis of greater than 50% or other epicardial vessel stenosis of greater than 70%, was present in 7 patients; 6 received percutaneous coronary intervention and 1 received coronary artery bypass grafting before transplantation. RESULTS Groups were similar with regard to sex, race, or length of intensive care days. The group with normal coronary arteries was significantly younger than the groups with coronary artery disease. The revascularized group had a significant increase in dysrhythmias (P < .003) and 1-, 3-, and 5-year survivals of 85%, 85%, and 69%, respectively. Those with insignificant coronary artery disease (14 patients) demonstrated a 1-, 3-, and 5-year survival of 64%, 40%, and 32%, respectively. The normal coronary group (151 patients) had a 1-, 3-, and 5-year survival of 75%, 58%, and 40%, respectively. The revascularized group had a significant survival advantage compared with that of the insignificant coronary artery disease group (P < .04, log-rank test). CONCLUSION Long-term survival of lung transplant recipients with revascularized coronary arteries is similar to that of subjects with normal coronary arteries, despite an increased incidence of dysrhythmias. Lung transplant recipients with insignificant coronary artery disease had a worse survival than the revascularized group. More studies are needed to ascertain the cause and determine the optimal management for lung transplant recipients with insignificant coronary artery disease.
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Affiliation(s)
- Leonardo Seoane
- Ochsner Multi-Organ Transplant Center, Department of Surgery, New Orleans, LA 70121, USA.
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Abstract
Lung transplantation remains the only therapeutic option shown to improve survival for many end-stage interstitial lung diseases. Although idiopathic pulmonary fibrosis is the most common indication, transplantation has been performed for many other diseases. This article reviews the current indications and outcomes for the procedure and problems encountered in lung transplantation for interstitial lung diseases. The role of transplant for specific diseases also is discussed.
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Affiliation(s)
- Brandon S Lu
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA
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