Thorac Cardiovasc Surg 2018; 66(S 02): S111-S138
DOI: 10.1055/s-0038-1628355
Short Presentations
Tuesday, February 20, 2018
DGPK: Various II
Georg Thieme Verlag KG Stuttgart · New York

Cardiac Allograft Vasculopathy Is Reversible: Also in Higher Stages

S. Ulrich
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
A. Lehner
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
S. Rodriguez Fernandez
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
J. Birnbaum
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
L. Hakami
2   Department of Heart Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
,
M. Fischer
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
R. Pozza Dalla
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
,
N. Haas
1   Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: Cardiac allograft vasculopathy (CAV) is a crucial problem concerning the long-term prognosis after heart transplantation, in adults as well as in children. Intravascular imaging, for example optical coherence tomography (OCT) is able to detect already very early stages of this disease concerning the three layered wall of the coronary arteries. These early stages of CAV seem to be reversible with reduction of the cardiac risk factors and optimization of the immunosuppressive therapy. To what extent also higher stages of CAV can be reversible is unclear up to now.

Methods: Retrospective analysis of the development of the CAV, according to the Stanford classification, in patients after pediatric heart transplantation in the department for pediatric cardiology and intensive care medicine at the Ludwig-Maximilians-University in Munich. Patients with at least two examinations of intravascular imaging were included.

Results: Between 2013 and 2017, more than 35 patients underwent at least two heart catheter examinations with intravascular imaging, OCT or intravascular ultrasound (IVUS). The development of the CAV was very heterogeneous in these patients. The majority of the patients showed a stable result of the CAV over the years. In some cases there was an aggravation; however, only one patient showed a restricted heart function and none of the patients needed re-transplantation. Improvement of the disease could be detected especially in patients with mild CAV (Stanford I and II). However strict optimization of the weight, the lipid metabolism and the blood pressure as well as adapted immunosuppressive therapy enable also an improvement of the CAV in higher stages, even with changes in the coronary angiography.

Conclusion: Early detection of CAV is very important, as even higher stages of CAV with changes in the coronary angiography can be reversible with optimal adjustment of the cardiac risk factors as well as adapted immunosuppressive therapy.