Chronic total occlusion percutaneous coronary intervention in heart transplant patients

Catheter Cardiovasc Interv. 2023 Jan;101(1):102-107. doi: 10.1002/ccd.30476. Epub 2022 Nov 15.


Cardiac allograft vasculopathy (CAV) is frequently observed after heart transplant (HT), and represents one of the main causes of chronic rejection, graft loss, and death. While the role of percutaneous coronary intervention (PCI) is well established in the management of CAV in cases of nonocclusive stenoses, the outcomes and technical aspects of this procedure in chronic total occlusions (CTOs) are unknown. We describe our experience with three cases in which CTO PCI was indicated to treat CAV in HT recipients, and we discuss the peculiarities and therapeutic approach to this challenging patient population. In particular, all patients were asymptomatic for angina, and CTO PCI was indicated to promote recovery of left ventricular function, extend graft survival, and/or protect from future ischemic events. CTO PCI was performed using hybrid techniques and was successful in all three cases. Intravascular imaging was used in all cases to maximize the durability of the procedure.

Keywords: cardiac allograft vasculopathy; chronic total occlusion; heart transplant; percutaneous coronary intervention.

Publication types

  • Case Reports

MeSH terms

  • Chronic Disease
  • Coronary Angiography
  • Coronary Occlusion* / diagnostic imaging
  • Coronary Occlusion* / etiology
  • Coronary Occlusion* / therapy
  • Heart Transplantation* / adverse effects
  • Humans
  • Percutaneous Coronary Intervention*
  • Risk Factors
  • Treatment Outcome
  • Ventricular Function, Left