Abstract
Purpose Coronary artery fistulae (CAF) occur with a high frequency in orthotopic heart transplantation (OHT) patients. It is unknown whether CAF formation has any relationship with development of transplant coronary artery disease (TCAD). Methods and Materials We evaluated 432 consecutive coronary angiograms of recipients transplanted from 1994-2011. Presence of CAF and TCAD were recorded. TCAD was defined as angiographic epicardial stenosis ≥ 30%. Unpaired t test and Fisher’s exact test were used for statistical analysis. Results A total of 212 CAF were identified in 163 patients (37.7% of all patients) within one year post OHT. The most common termination structures were the pulmonary artery (55.7%), right atrium (23.1%), thoracic vessel (7.5%), and right ventricle (6.6%). During angiographic follow-up of 5.2±4.3 years, TCAD occurred in 9.8% of patients with CAF compared to 20% of patients without CAF (p=0.005). Immunosuppression with tacrolimus and mycophenolate mofetil was more frequent in patients with CAF (72%) compared to patients without CAF (58%) (p=0.005). Other transplant characteristics were not statistically different. Conclusions CAF formation after OHT is associated with a 50% decrease in downstream development of TCAD. The implications of this finding and the mechanism of CAF formation in OHT will require further investigation. Transplant Characteristics in Patients With and Without Coronary Artery Fistulae (n=432) Coronary Artery Fistulae (n=163) No Coronary Artery Fistulae (n=269) p value Female 36 (22.1%) 50 (18.6%) 0.39 Transplant Age (years) 55 ± 14 56 ± 13 0.55 Donor Age (years) 31 ± 12 30 ± 11 0.18 Ischemic Time (minutes) 193 ± 78 178 ± 68 0.070 Previous Sternotomy 76 (46.6%) 107 (39.8%) 0.19 Cytomegalovirus Mismatch 30 (18.4%) 67 (24.9%) 0.12 Ischemic Reason for Transplant 74 (45.4%) 123 (45.7%) 1.0 Induction Therapy 55 (33.7%) 96 (35.7%) 0.75 Rejection within Year 1 of Transplant 11 (6.7%) 24 (8.9%) 0.47 Transplant Coronary Artery Disease 16 (9.8%) 54 (20.1%) 0.005
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