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Cardiac allograft vasculopathy: A review.

Publication ,  Journal Article
Lee, MS; Tadwalkar, RV; Fearon, WF; Kirtane, AJ; Patel, AJ; Patel, CB; Ali, Z; Rao, SV
Published in: Catheter Cardiovasc Interv
December 1, 2018

Cardiac allograft vasculopathy (CAV) is a complex disease that remains a significant cause of morbidity and mortality after orthotopic heart transplantation (OHT). Originating as a result of inflammatory response, the development and progression of CAV is attributed to endothelial dysfunction, cellular infiltration, and a wide-range of genetic and patient factors. The detection of CAV remains a diagnostic challenge, as symptoms can be variable or absent. While coronary angiography remains the initial test of choice for the diagnosis and surveillance of CAV, intravascular imaging (either by ultrasound or optical coherence tomography) and physiologic assessments are useful adjuncts in the cardiac catheterization laboratory. Positron emission tomography, computed tomographic, and magnetic resonance imaging may have a role increasing the time interval between invasive screening tests for prognosis. Medical management should include a statin, vasodilator, and tailored immunosuppressive regimen that maximally decrease allograft rejection and CAV progression while causing minimal side effects. Patients that are less responsive to pharmacotherapy should be considered for invasive management with percutaneous coronary intervention. Although surgical revascularization is a poor option, repeat OHT is the only definitive treatment option but given its morbidity should be reserved for a highly selected patient population.

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Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

December 1, 2018

Volume

92

Issue

7

Start / End Page

E527 / E536

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Reoperation
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Immunosuppressive Agents
  • Humans
  • Heart Transplantation
  • Graft Survival
  • Coronary Artery Disease
 

Citation

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Lee, M. S., Tadwalkar, R. V., Fearon, W. F., Kirtane, A. J., Patel, A. J., Patel, C. B., … Rao, S. V. (2018). Cardiac allograft vasculopathy: A review. Catheter Cardiovasc Interv, 92(7), E527–E536. https://doi.org/10.1002/ccd.27893
Lee, Michael S., Rigved V. Tadwalkar, William F. Fearon, Ajay J. Kirtane, Amisha J. Patel, Chetan B. Patel, Ziad Ali, and Sunil V. Rao. “Cardiac allograft vasculopathy: A review.Catheter Cardiovasc Interv 92, no. 7 (December 1, 2018): E527–36. https://doi.org/10.1002/ccd.27893.
Lee MS, Tadwalkar RV, Fearon WF, Kirtane AJ, Patel AJ, Patel CB, et al. Cardiac allograft vasculopathy: A review. Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E527–36.
Lee, Michael S., et al. “Cardiac allograft vasculopathy: A review.Catheter Cardiovasc Interv, vol. 92, no. 7, Dec. 2018, pp. E527–36. Pubmed, doi:10.1002/ccd.27893.
Lee MS, Tadwalkar RV, Fearon WF, Kirtane AJ, Patel AJ, Patel CB, Ali Z, Rao SV. Cardiac allograft vasculopathy: A review. Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E527–E536.
Journal cover image

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

December 1, 2018

Volume

92

Issue

7

Start / End Page

E527 / E536

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Reoperation
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Immunosuppressive Agents
  • Humans
  • Heart Transplantation
  • Graft Survival
  • Coronary Artery Disease