Coronary Artery Vasculopathy in a Cohort of Heart Transplant Recipients: A Single Center Experience

Coronary allograft vasculopathy (CAV) is a significant cause of late mortality in heart transplant recipients. This study assesses the development of CAV, associated rejection rates, and the potential impact of percutaneous coronary intervention (PCI) on survival in a cohort of heart transplant patients.

We conducted a retrospective analysis of 321 patients who underwent orthotropic heart transplantation (OHT) at Virginia Commonwealth University between October 2008 and September 2021. Data on CAV incidence, PCI, rejection, and mortality were collected. CAV severity was classified by ISHLT criteria, and Kaplan-Meier analysis was used to evaluate survival.

CAV occurred in 55 patients (17%), with a median onset of 2.81 years. Nineteen of these patients required PCI, including three for chronic total occlusion (CTO). Overall mortality was higher in the CAV group compared to the non-CAV group (40% vs. 27%, p = 0.045). Kaplan-Meier analysis revealed no overall survival difference between CAV and non-CAV patients (p = 0.558). Excluding patients with less than 2 years of follow-up, survival significantly favored the non-CAV group (5-year survival: 93% vs. 86%; 10-year survival: 75% vs. 62%, p = 0.023). Patients with CAV who underwent PCI had survival outcomes comparable to those with less severe CAV (p = 0.75). One case involved a 67-year-old female with a right coronary artery CTO, successfully treated with PCI, which maintained vessel patency for an additional 2 years and potentially preserved allograft function.

CAV is a late complication associated with increased mortality, especially in those with moderate to severe rejection. PCI in patients with advanced CAV may help improve survival to levels comparable with less severe CAV. Further research is needed to better understand non-immunologic factors and the role of PCI in long-term outcomes.