心脏移植物血管病变特点和介入治疗八例分析

The Characteristics and Clinical Outcomes of 8 Patients With Cardiac Allograft Vasculopathy Treated With Percutaneous Coronary Intervention

目的:分析心脏移植物血管病变(CAV)特点和接受经皮冠状动脉介入治疗(PCI)的临床结果。方法:在2012年9月至2018年6月期间,阜外医院共进行454例心脏移植。移植前供体心脏冠状动脉均正常。本研究回顾性分析确诊为CAV并接受冠状动脉造影和PCI治疗患者的临床症状、病变特点、治疗情况和远期随访结果。结果:接受PCI治疗的8例(1.8%)CAV患者中,男性7例,女性1例。接受心脏移植时年龄(41.9±16.1)岁,心脏移植后至接受PCI的时间为(6.1±2.4)年。患者因胸痛、呼吸困难、乏力、恶心、头晕等症状住院,但仅4例(50%)为典型胸痛症状者。药物洗脱支架(DES)共治疗成功11处病变。术后平均电话随访(31.4±24.7)个月,4例患者冠状动脉造影复查,3例患者有3处靶病变发生支架内再狭窄(ISR),2例患者有6处病变为闭塞性病变接受再次PCI。未行冠状动脉造影复查的4例患者,2例患者发生心原性死亡。结论:发生CAV的患者缺血症状不典型,弥漫性闭塞病变发生率较高,PCI是CAV的主要治疗手段。

Objectives:To analyze the clinical characteristics and clinical outcomes of 8 patients with cardiac allograft vasculopathy(CAV) treated with percutaneous coronary intervention(PCI).Methods:A total of 454 patients underwent heart transplantation in fuwai hospital from September 2012 to June 2018.The coronary arteries of the donor heart were normal before transplantation.The present study retrospectively analyzed the clinical symptoms,lesion characteristics,treatment and long-term follow-up results of 8 patients with CAV treated with PCI.Results:Among the 8(1.8%) CAV patients(7 males,1 female) treated with drug-eluting stent percutaneous coronary intervention(PCI DES),the mean age in heart transplantation was(41.9±16.1) year and the mean time from heart transplantation to first intervention was(6.1±2.4)years.The patients were hospitalized due to chest pain,dyspnea,fatigue,nausea,dizziness.However,only 4 cases(50%) were typical chest pain symptoms.Among 11 lesions treated with PCI DES,6 were chronic occlusion lesions.During a mean follow-up with telephone after PCI DES of(31.4±24.7)months,4 patients were followed up with coronary angiography(CAG) after PCI DES.In-stent restenosis(ISR) occurred in 3 lesions,2 patients underwent PCI DES again.Among the other 4 patients without CAG after PCI,2 deaths occurred after PCI DES.Conclusions:CAV patients often present with atypical ischemic symptoms and the incidence of diffuse occlusion lesions is high.PCI is still the main treatment of CAV.