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do not change during prednisone weaning, there are individual variations in response.
GEP score change during prednisone weaning is not influenced by gender, age or he-modynamics. This heterogeneity in GEP response has to be borne in mind when usingthese results exclusively to guide weaning pts from prednisone following TX. Further,larger studies are needed to study this preliminary observation.
Is Drug-Eluting Stent a Choice for Treatment of Cardiac TransplantArteriopathy?Darlene , Abul , Joyce W, James A. BurkePenny ParkerBrian, Nelson W, James T. Fitzeral, Lazaros NikolaidisAlfred A. Bove1Section of Cardiology, Temple University, Philadelphia, PA Introduction: Transplant arteriopathy is treated with augmentation of immunosup-pression and sometimes, repeat transplantation (HTx). Treatment of focal (type A)coronary artery disease in the cardiac allograft is less clear. PTCA has been success-ful, but with a high restenosis rate. The procedural success and long term patency ofstenting in this population has not yet been reported. Methods: We reviewed the da-tabase at the Temple University Hospital Transplant program (1992e2006) and ana-lyzed heart failure patients (n 5 26), who developed focal coronary stenosis andtreated by coronary stenting. Results: Mean age for the stented patients were59 6 10, female 16%, and transplanted within the last 10 years. 100% proceduralsuccess rate was found in twenty-six patients who required intra-coronary stentingfollowing HTx. DES cypher (22%), DES taxus (59%), Bare metal (15%), angioplastyand others (4%) were used in 26 patients. 56% had 1 stent, 16% 2 stents, 16% 3 stents,and 12% had 4 stents placed at different time intervals. Stents locations: LAD (prox-7%,mid-16%,distal-2%), RCA (prox-14%,mid-9%,distal-7%), LCx (prox-14%,mid-5%), OM-19%, Right marginal-2%, RPL-2%, Left Main-2%. 6-months follow up(f/u) was performed on 17 patients (8 patients were not due for f/u). 9 patients under-went nuclear imaging, 3 dobutamine stress echo and 5 left heart catheterization re-vealing a clinical patency rate of 100% at 6 months. At 1-year f/u, one stent(DES) was occluded. 6 underwent left heart catheterization and 11 had nuclear stressecho done. The patency rate at 1-year was 80%. Conclusions: Previously, PTCA postcardiac transplant has shown an approximately 93% success rate with a 55% resteno-sis rate at 7 months. Direct coronary atherectomy had an 82% angiographic successrate with significant complication rate. CABG has also been performed, with a 67%survival to discharge. We found 100% success rate with coronary stenting in thetransplanted heart, a 100% clinical patency rate at 6 months and 80% patency at12 months, with angiographic confirmation in 60% of patients. Graft function andimpact on survival need to be further evaluated.
The Use of a Viable, Biodegradable 3-Dimensional Fibroblast Construct (3DFC)in Acute and Chronic Heart FailureHoang M. ,Tracy Hagert, Rose D, Elizabeth Juneman, Jordan Gene Expression Profiling (AlloMap) Scores in Post Heart Transplant Patients 2Cardiology/Medicine, SAVAHCS Medical Center, Tucson, AZ; 3Biomedical Engineering, University of Arizona, Tucson, AZ Kishan JastiDiane V, Cynthia , Stephen , David , Srinivas; 1Cardiac Transplant Program, Allegheny General Hospital, Pittsburgh, PA Background: This study was designed to determine if a viable, biodegradable 3-dimensional fibroblast construct (3DFC) patch implanted on the left ventricle (LV) Background: Gene expression profiling (GEP) discriminates between quiescence after myocardial infarction (MI) improves LV function and alters LV remodeling af- and moderate to severe acute cellular rejection in cardiac transplant (TX) patients ter acute MI and in chronic heart failure (CHF). Methods: We ligated the left coro- (pts). GEP scores increase both with the time elapsed post-TX and with prednisone nary artery of adult male Sprague-Dawley rats and implanted the 3DFC patch on the taper. Weaning from prednisone is usually done with serial surveillance endomyocar- infarcted anterior wall acutely as well as 3 weeks after MI. Hemodynamic and echo- dial biopsies. Whether serial GEP can be used to aid weaning from prednisone in TX cardiographic studies were performed 3 weeks after 3DFC implantation in both pts has not been systematically evaluated. Hypothesis: We hypothesized that serial groups. Results: Acute 3DFC patch implantation improved LV systolic function GEP correlate with biopsy results in the detection of rejection or quiescence and by increasing (P ! 0.05) LV ejection fraction (LVEF) (37.1 6 3.3 to 61.7 6 can be used during prednisone weaning in TX pts. Methods: We evaluated 24 pts 4.9%) and regional systolic displacement of the infarcted wall (0.04 6 0.02 to who were O 1 year post eTX and candidates for prednisone weaning. There were 0.11 6 0.03 cm); increased cardiac output from 0.10 6 0.01 to 0.38 6 0.07 ml/ 7 females (29.2%) and 17 males (70.8%). The mean age was 55.8 6 10.9 (median 5 min and shifted the passive LV diastolic pressure volume relationship to the left to- 58.5 years). Background immunosuppression consisted of Tacrolimus and mycophe- ward the pressure axis. The acute placement of a 3FDC patch also attenuated LV re- nolate mofetil. All patients underwent serial, simultaneous GEP and endomyocardial modeling by decreasing LV end-diastolic diameter by 19% (P ! 0.05) with no biopsy assessment during the weaning process. Biopsies were graded using the Inter- change in LV end-systolic diameter. The 3DFC patch did not change LV end-diastolic national Society for Heart & Lung Transplantation (ISHLT) grading system by a pa- pressure (LV EDP) 25 6 2 versus 23 6 2 mmHg but the addition of captopril (2mg/L thologist blinded to the GEP scores. Results: All pts had ISHLT Grade OR or 1R on drinking water) lowered (P ! 0.05) LV EDP to 12.9 6 2.5 mmHg and shifted the biopsy during the weaning process. The mean GEP score did not change during pred- pressure-volume relationship, decreasing (P ! 0.05) the LV operating end-diastolic nisone weaning (30 6 6 vs. 31 6 6). Pts were grouped based on change in GEP scores volume from 0.49 6 0.02 to 0.34 6 0.03 ml. In CHF, when implanted 3 weeks after during prednisone weaning. The GEP scores either decreased (at least 3 points) in MI, the 3DFC patch also improved LV systolic function (P ! 0.05) (LVEF, 41.5 6 7 pts (29.2%), increased (at least 3 points) in 6 pts (25%) or remained unchanged 5.9% to 53.0 6 3.9%). However, this was not accompanied by any effect on LV in 11 pts (45.8%) during serial assessment. Change in GEP score was not indepen- remodeling, as LV end-diastolic diameter remained dilated with the addition of the dently associated with gender (p 5 0.15), although more males than females had 3DFC patch. Conclusion: Our study demonstrates that a biodegradable 3DFC patch increases in their GEP scores (29.4% vs. 14.3%). Males were older than females implanted acutely can provide a matrix support structure that results in improved LV (58.2 6 9.6 vs. 50.0 6 12.4 years) but age was not significantly different between function and attenuated LV remodeling 3 weeks after MI. In CHF, the same patch groups (p 5 0.09).There were no significant differences in any hemodynamic param- improved LV function but did not affect LV remodeling. The use of a viable fibroblast eter (right atrial pressures, pulmonary pressures, wedge pressures, cardiac output) be- matrix patch is a compelling new approach to cell-based therapy for acute MI and tween the three GEP score change groups. Conclusion: Though the mean GEP scores
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