Update in the Use of Percutaneous Coronary Intervention for Cardiac Allograft Vasculopathy After Heart Transplantation

Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation. CAV with discrete or tubular lesions can be treated with percutaneous coronary intervention (PCI) with high procedural success. Revascularization with balloon angioplasty, bare-metal stents, and first-generation drug-eluting stents has been associated with high and unacceptable restenosis rates. However, second-generation drug-eluting stents are associated with favorable stent and lesion patency. Stent and lesion patency now closely resemble the expected rates in their use in non-transplant CAD. A PCI strategy with routine follow-up surveillance angiography is associated with favorable survival, and should be considered established therapy especially in patients who are ineligible for re-transplantation. Drug-coated balloons may offer an alternative revascularization option and require a shorter duration of dual anti-platelet therapy. Randomized data is needed to determine who to treat, when to treat, and with what to treat CAV after heart transplantation, and the optimal duration of dual anti-platelet therapy.