Transmyocardial revascularization for cardiac transplantation allograft vasculopathy

Cardiac allograft vasculopathy is a leading cause of death after heart transplantation. Virtually all cardiac transplant recipients exhibit some histopathologic evidence of vasculopathy 1 year after transplantation. Management options for patients with myocardial ischemia caused by this condition have been limited to medical therapy, coronary revascularization, or cardiac retransplantation. To determine whether transmyocardial laser revascularization (TMR) is an effective treatment for cardiac allograft vasculopathy after cardiac transplantation, we performed holmium laser revascularization on four patients with myocardial ischemia who met research protocol criteria.