Cardiac allograft vasculopathy medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Once CAV has developed, pharmacologic options to halt progression are limited. Moreover, outcomes resulting from available treatment have been disappointing. Retransplantation is the only definitive treatment of established CAV. Ideal regimen should not affect the lipid profile, blood pressures and renal function, and should have a positive impact on hemodynamics. | |||
==Medical Therapy== | ==Medical Therapy== | ||
=== | Treatment option for established CAV include: | ||
{|class="wikitable" border="1" | |||
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|'''Pharmacological Management''' | |||
|'''Non-pharmacological Interventions''' | |||
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* [[Sirolimus]] | |||
* [[Everolimus]] | |||
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* Retransplantation | * Retransplantation | ||
* [[Percutaneous coronary intervention]]s | * [[Percutaneous coronary intervention]]s | ||
* [[Coronary artery bypass grafting]] | * [[Coronary artery bypass grafting]] ([[CABG]]) | ||
* [[Transmyocardial revascularization]] | * [[Transmyocardial revascularization]] | ||
* Heparin induced/mediated extracorporeal LDL plasmapheresis (HELP) | * [[LDL apheresis|Heparin induced/mediated extracorporeal LDL plasmapheresis]] (HELP) | ||
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===Pharmacologic Management=== | |||
====High Dose Immunosuppressive Therapy==== | |||
* Lamich and colleagues <ref name="pmid9708469">{{cite journal| author=Lamich R, Ballester M, Martí V, Brossa V, Aymat R, Carrió I et al.| title=Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation. | journal=J Am Coll Cardiol | year= 1998 | volume= 32 | issue= 2 | pages= 413-9 | pmid=9708469 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9708469 }} </ref> studied the effects of augmented immunosuppressive therapy on progression of established CAV in a prospective trial of 76 cardiac allograft recipients. They concluded that the likelihood of CAV regression is higher when treatment was instituted within one year of transplant (92%) compared to after one year (40%) (P=0.033). | |||
* However, this is not routinely practiced as the risks of high dose immunosuppressive therapy outweighs the benefits. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:49, 20 December 2014
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Cardiac allograft vasculopathy medical therapy On the Web |
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American Roentgen Ray Society Images of Cardiac allograft vasculopathy medical therapy |
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Directions to Hospitals Treating Cardiac allograft vasculopathy |
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Risk calculators and risk factors for Cardiac allograft vasculopathy medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Once CAV has developed, pharmacologic options to halt progression are limited. Moreover, outcomes resulting from available treatment have been disappointing. Retransplantation is the only definitive treatment of established CAV. Ideal regimen should not affect the lipid profile, blood pressures and renal function, and should have a positive impact on hemodynamics.
Medical Therapy
Treatment option for established CAV include:
| Pharmacological Management | Non-pharmacological Interventions |
Pharmacologic Management
High Dose Immunosuppressive Therapy
- Lamich and colleagues [1] studied the effects of augmented immunosuppressive therapy on progression of established CAV in a prospective trial of 76 cardiac allograft recipients. They concluded that the likelihood of CAV regression is higher when treatment was instituted within one year of transplant (92%) compared to after one year (40%) (P=0.033).
- However, this is not routinely practiced as the risks of high dose immunosuppressive therapy outweighs the benefits.
References
- ↑ Lamich R, Ballester M, Martí V, Brossa V, Aymat R, Carrió I; et al. (1998). "Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation". J Am Coll Cardiol. 32 (2): 413–9. PMID 9708469.