Combined coronary intervention in heart-transplant patient with rapidly accelerated cardiac allograft vasculopathy
1Department of Surgery, Saitama Medical School, Saitama, Japan.
Insights
A heart transplant recipient developed accelerated cardiac allograft vasculopathy, a severe form of coronary artery disease in transplanted hearts. Despite interventions, the patient succumbed to multiple organ failure, highlighting the challenges in managing post-transplant cardiovascular complications.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Dilated cardiomyopathy necessitates heart transplantation for end-stage heart failure.
- Coronary artery disease in donor hearts poses a risk for post-transplant complications.
- Cardiac allograft vasculopathy (CAV) is a major long-term concern after heart transplantation.
Observation:
- A 46-year-old male recipient developed CAV with triple-vessel disease 15 months post-transplant.
- Initial postoperative angiography showed mild stenosis; accelerated progression was noted later.
- The patient experienced multiple rejection episodes, indicating immune system involvement.
Findings:
- Percutaneous transluminal coronary angioplasty provided only temporary relief, with rapid restenosis and new lesions.
- Quadruple coronary artery bypass grafting was performed due to financial inability to undergo re-transplantation.
- A biventricular assist device was required, but the patient ultimately died of multiple organ failure.
Implications:
- This case underscores the aggressive nature and poor prognosis of accelerated CAV.
- Management of CAV requires aggressive and often multi-modal therapeutic strategies.
- The financial burden of advanced cardiac care, including re-transplantation, is a critical factor in patient outcomes.
Abstract:
A 46-year-old man accepted for heart transplantation due to persistent cardiac failure from dilated cardiomyopathy underwent a transplant in Germany on July 13, 1995. The donor heart was suspected of coronary artery disease at explantation, but he could wait no longer because of his rapidly deteriorating hemodynamics. Postoperative coronary angiography revealed 25% stenosis of the left descending artery. He showed several episodes of minimal or moderate rejection postoperatively, and coronary angiography 15 months postoperatively showed rapidly accelerated cardiac allograft vasculopathy demonstrating triple vessel disease with multiple lesions. Percutaneous transluminal coronary angioplasty was successful on 2 coronary vessels, but immediately recurrent stenosis and new lesions involving the left main trunk occurred 6 weeks thereafter. Since he was financially unable to afford a second heart transplantation, quadruple coronary artery bypass grafting was conducted October 25, 1996. A biventricular assist device was used when he could not be weaned from cardiopulmonary bypass. He died of multiple organ failure 3 days after surgery.
