Percutaneous Coronary Interventions and Bypass Surgery in Patients With Cardiac Allograft Vasculopathy: A Single-Center Experience

Cardiac Surgery after Heart Transplantation - Elective Operation or Last Exit Strategy?

“…30 One of our patients needed retransplantation because of progressive CAV 9 months after CABG (LIMA ad left anterior descendens, vein ad circumflex artery). However, retransplantation remains an ethical question with worldwide organ shortness.…”

“…3,[20][21][22][23][24][25] Concerning the treatment of CAV with coronary artery bypass grafting (CABG), there are single-center experiences and even a published recommendation that CABG can be performed in type A lesions even though it has limited efficacy in diffuse distal artery disease. [26][27][28][29][30] When performed in selected patients, the operation seems to be safe. 2,5,14 Retransplantation remains the last therapeutic option for cardiac allograft failure due to progressive CAV.…”

Transplant coronary heart disease: challenges and solutions

“…These tests provide prognostic information, since a positive test result usually signifies advanced disease. 1,3,43,44 Other parameters on stress testing have been studied as possible markers for CAV. Systolic dysfunction and wall motion abnormalities on resting echocardiography or reduced mitral annular systolic tissue Doppler velocities (s') #10 cm/s …”

“…42,55,70,71 Given the diffuse nature of CAV, revascularization is often not feasible, although both surgical and percutaneous revascularization can be successful for discrete proximal CAV lesions. 5,44,55 Percutaneous coronary intervention (PCI) with stenting is preferred for patients with focal lesions amenable to this procedure. Restenosis rates are 18% with drug-eluting stents and up to 43% with bare-metal stents.…”

“…73 Fewer OHT recipients with CAV are candidates for coronary artery bypass grafting (CABG) than for PCI, but the highly-selective CAV patients undergoing CABG may have favorable outcomes. 5,44,55 CAV is the most common indication for retransplantation, which remains the definitive therapy when CAV is not amenable to revascularizations (Table 3). 2,[5][6][7]41,55,74,75 Conclusion CAV is common after OHT and associated with significant morbidity and long-term mortality.…”