PHILADELPHIA — Patients with mild or moderate coronary artery disease can safely undergo lung transplantation, according to a review of more than 200 patients at Washington University in St. Louis.
In this series, the incidence of perioperative death, long-term death, and long-term cardiac morbidity was similar between patients with mild or moderate CAD and those with no detectable disease, Cliff K.C. Choong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.
Most U.S. transplant centers do lung transplantation in patients with mild or moderate CAD, but this is the first report to document that this approach is okay, said Dr. Choong, who is now a cardiothoracic surgeon at Papworth Hospital, Cambridge, England.
Patients with severe CAD—at least one coronary artery stenosis of 50% or greater—would require revascularization before undergoing lung transplantation, Dr. Choong told this newspaper. This should only be an option if the CAD is discrete, if left ventricular function is normal, and if the coronary anatomy is suitable for revascularization. If feasible, it should be done during the lung transplant surgery, preferably with stents, because coronary artery bypass surgery during lung transplantation requires more complex surgery that takes substantially more time, he said.
The study reviewed all 268 adults who had lung transplantation surgery at Washington University during June 1998-June 2003. Patients were excluded if they had sever CAD (3) or if they didn't undergo coronary angiography before transplant (55).
At the university, lung transplant candidates undergo routine coronary angiography if they are at least 45 years old, regardless any history or symptoms of CAD. Younger patients have angiography only if they also have risk factors for CAD.
Of the 210 patients, 177 had no evidence of CAD, 16 patients had mild CAD (coronary stenosis of less than 30%), and 17 had moderate CAD (stenosis of 30%–50%).
Thirteen of the 177 patients with no CAD died while they were hospitalized for their transplantation, compared with none of the 33 patients with CAD, he said. During an average follow-up of about 2 years, mortality was 23% in the patients without CAD and 27% in those with CAD.