Outcomes After Percutaneous Coronary Intervention in Coronary Allograft Vasculopathy After Heart Transplantation: A Single Center Review

Abstract

<h3>Purpose</h3> Coronary allograft vasculopathy (CAV) remains a significant contributor to long term mortality after orthotopic heart transplantation (OHT). Treatment options after the development of CAV remain limited. We reviewed the outcomes at our center of patients after OHT who developed CAV and were treated with percutaneous coronary intervention (PCI). <h3>Methods</h3> We reviewed the charts of all adults (age >18 years) transplanted at our center and identified all patients who received PCI for CAV from 2008 to 2021. Outcomes, including comorbidities, immunosuppression, PCI type, overall survival, and graft survival were reviewed. <h3>Results</h3> During the study period, 14 patients underwent PCI for CAV, receiving a total of 39 stents (19 in the LAD, 6 in the LCX, 2 in an OM, 1 in the ramus, and 11 in the RCA). The mean duration from date of transplant to first stent in these patients was 8.1 years. All of these stents were drug eluting stents, the vast majority 3rd generation. Over a mean follow-up period of 3.4 years, stent patency was noted to be 82% based on repeat coronary angiogram. 2-year graft survival after PCI was 77% (overall survival 85%). 5-year graft survival after PCI was 63% (overall survival 71%). Of note, 50% of patients who had in-stent restenosis requiring repeat intervention died during the study period. <h3>Conclusion</h3> In this single center study, patients found to have CAV after OHT who were treated with PCI were found to have an acceptable rate of stent patency on follow-up coronary angiograms but long term survival remained significantly impacted.