Cardiac allograft vasculopathy--coronary interventions and surgical options

Despite improved results early after heart transplantation (HTX) obstructive allograft vasculopathy still remains the leading cause of death late after HTX. Studies in the past, focused on angioplasty (PTCA), presented with disappointing results. Using intravascular ultrasound an extensive early recoil could be shown to be the major cause for re/rest-stenosis in dilated lesions. Stimulated by these observations, stent implantation was recently shown to be an effective therapeutical alternative in focal luminal obstruction in graft coronary arteries. Treatment of 41 patients in a single center experience (75 lesions, 85 stents) resulted in a success rate of 98%; no acute or subacute stent thromboses were observed (protocol with ASS and Ticlopidine). Control angiography revealed a 6-month restenosis rate of 14.1% defining stent implantation as the method of choice for relief of focal luminal obstruction. Only limited experience is available regarding the surgical approach with coronary artery bypass grafting. In selected patients (focal obstruction not suitable for interventional therapy, adequate peripheral vessels) it might represent a therapeutical alternative.