Coronary Revascularisation Strategies for Patients with Obstructive Coronary Artery Disease Requiring Lung Transplantation: A Narrative Review and Single-Centre Experience.

BACKGROUND

Lung transplant (LTx) candidates often have multiple risk factors for coronary artery disease (CAD), which was previously considered a contraindication to transplantation. Improvements in revascularisation techniques have broadened transplant eligibility; however, because available evidence is based on small and heterogeneous cohorts, the optimal revascularisation strategy remains unclear.

METHOD: We conducted a literature review and describe our centre's experience with current approaches to revascularisation in LTx candidates with obstructive CAD.

RESULTS

The literature review identified 174 studies in the initial search, of which 29 studies were considered relevant. However, only six retrospective studies directly compared percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), comprising 376 revascularised patients. In some cohorts, CABG was associated with longer ventilation time and longer intensive care unit (ICU) stay and overall hospital stay, although this finding was not consistent across all studies. At our centre, 20 patients underwent concomitant CABG, and 11 underwent PCI within 12 months before transplant listing, after obstructive CAD was diagnosed during transplant assessment. Procedure time in patients undergoing concomitant CABG was significantly longer (1.2 hours; p<0.05); however, all patients in this group underwent bilateral transplantation. Three patients in the PCI group experienced postoperative coronary events, and overall mortality was higher in this group. There were no differences in other outcomes, including ICU and overall length of stay.

CONCLUSIONS

These findings highlight the heterogeneity and complexity of this patient cohort. Although no patients who underwent CABG experienced postoperative coronary events, the limited published evidence does not support a single preferred revascularisation strategy for patients being considered for lung transplantation. Case-by-case management guided by a multidisciplinary team is therefore warranted.