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Updated: Aug 21, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Chronic total occlusion percutaneous coronary intervention in heart transplant patients
Lorenzo Azzalini1, Francesco Moroni2, Kathryn L Dawson1,3
1Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
Insights
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in cardiac allograft vasculopathy (CAV) after heart transplant (HT) is feasible. Hybrid CTO PCI techniques successfully treated CAV in three HT recipients, promoting graft survival and ventricular function.
Area of Science:
- Cardiology
- Transplant Surgery
- Interventional Cardiology
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of graft loss and mortality after heart transplant (HT).
- Percutaneous coronary intervention (PCI) is effective for non-obstructive CAV, but its role in chronic total occlusions (CTOs) remains unclear.
Observation:
- This study reports on three heart transplant recipients with CAV and CTOs who underwent CTO PCI.
- Patients were asymptomatic but CTO PCI was pursued to improve left ventricular function, prolong graft survival, and prevent future ischemic events.
Findings:
- CTO PCI was performed using hybrid techniques and was successful in all three cases.
- Intravascular imaging was utilized to enhance procedural durability.
Implications:
- CTO PCI represents a viable therapeutic option for managing CAV in heart transplant recipients with CTOs.
- These findings suggest that CTO PCI can improve long-term outcomes in this challenging patient population.
Abstract:
Cardiac allograft vasculopathy (CAV) is frequently observed after heart transplant (HT), and represents one of the main causes of chronic rejection, graft loss, and death. While the role of percutaneous coronary intervention (PCI) is well established in the management of CAV in cases of nonocclusive stenoses, the outcomes and technical aspects of this procedure in chronic total occlusions (CTOs) are unknown. We describe our experience with three cases in which CTO PCI was indicated to treat CAV in HT recipients, and we discuss the peculiarities and therapeutic approach to this challenging patient population. In particular, all patients were asymptomatic for angina, and CTO PCI was indicated to promote recovery of left ventricular function, extend graft survival, and/or protect from future ischemic events. CTO PCI was performed using hybrid techniques and was successful in all three cases. Intravascular imaging was used in all cases to maximize the durability of the procedure.
