Page 27 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Cardiac Allograft Vasculopathy (CAV) Surveillance and Intervention Protocol

CAV is the most common cause of late graft failure. The gold standard for imaging the coronaries is
cardiac catheterization angiography but as imaging techniques improve CT and MR may supersede
conventional angiography.

Surveillance

 Routine coronary artery angiograms at annual or biannual cardiac catheterizations

Contributing Factors and Interventions

 Hyperlipidemia
o Fasting lipid profile annually (or more frequently with at risk patients)
o Healthy diet (nutrition to consult with high risk patients)

o Exercise
o Treat elevated cholesterol and triglycerides with a statin. Obtain CK Total at
initiation of therapy and ~1 week after.
o Pravastatin (Pravachol)
 5 years old – 5 mg daily
 10 years old – 10 mg daily
 15 years old and >70 Kg – 20 mg daily
 Hypertension

o Monitor routinely
o Blood pressure lowering medications
 Obesity
o Weight management and exercise plan
 Diabetes

Classification and Severity of CAV by Angiogram

(J Heart Lung Transplant 2010;29:717–27)

 ISHLT CAV0 (Not significant): No detectable angiographic lesion
 ISHLT CAV1 (Mild): Angiographic left main (LM) <50%, or primary vessel with maximum
lesion of <70%, or any branch stenosis <70% (including diffuse narrowing) without
allograft dysfunction
 ISHLT CAV2 (Moderate): Angiographic LM <50%; a single primary vessel ≥70%, or
isolated branch stenosis ≥70% in branches of 2 systems, without allograft dysfunction
 ISHLT CAV3 (Severe): Angiographic LM ≥50%, or two or more primary vessels ≥70%
stenosis, or isolated branch stenosis ≥70% in all 3 systems; or ISHLT CAV1 or CAV2 with
allograft dysfunction (defined as LVEF ≤45% usually in the presence of regional wall

Updated November 9, 2017 27