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Published on: May 14, 2013
Cardiac allograft vasculopathy
Michael S Lee1, Will Finch, Giora Weisz
1University of California, Los Angeles Medical Center, Los Angeles, CA, USA.
Insights
Cardiac allograft vasculopathy (CAV) significantly impacts heart transplant recipients. Management involves immunosuppression, risk factor modification, and revascularization, but repeat transplantation remains the only definitive treatment.
Area of Science:
- Cardiology
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is a primary cause of death and illness after heart transplants.
- It involves immune-mediated endothelial damage, leading to vascular smooth muscle cell proliferation and narrowed arteries.
Purpose of the Study:
- To review the risk factors, diagnosis, management, and treatment of CAV.
- To highlight the limitations of current interventions and the need for further research.
Main Methods:
- Review of existing literature on CAV.
- Discussion of diagnostic tools like coronary angiography and intravascular ultrasound.
- Analysis of management strategies including immunosuppression, risk factor modification, and revascularization.
Main Results:
- CAV is driven by immunologic damage and endothelial infiltration.
- Percutaneous coronary intervention (PCI) has high immediate success but high in-stent restenosis rates, though drug-eluting stents offer improvement.
- Repeat transplantation is the only definitive treatment for CAV.
Conclusions:
- Optimal immunosuppressive and risk factor-modifying agents require further study.
- Randomized trials are essential to define the best revascularization strategies for CAV patients.
Abstract:
Cardiac allograft vasculopathy (CAV) is the most important cause of morbidity and mortality following cardiac transplantation. CAV is largely mediated by immunologic damage and infiltration of the endothelium, resulting in proliferation of vascular smooth muscle cells and subsequent luminal narrowing. There are various risk factors for the development and progression of CAV. Coronary angiography is the gold standard for the diagnosis of CAV; intravascular ultrasound also plays an important role. The management of CAV includes immunosuppression, drugs that modify conventional coronary artery disease risk factors, and percutaneous coronary intervention (PCI) or surgical revascularization for severe obstructive lesions. Although revascularization with PCI has a high immediate success rate, rates of in-stent restenosis are higher as compared with PCI of native coronary arteries, although the advent of drug-eluting stents has somewhat improved in-stent restenosis rates. Thus, the only definitive treatment of CAV is repeat transplantation. Randomized trials are needed to determine the optimal immunosuppressive and conventional risk factor-modifying agents and revascularization strategies for patients who develop CAV.
