Does mechanical circulatory support prior to heart transplantation influence early onset of coronary allograft vasculopathy?

Introduction: Heart transplantation (HTx) is a common surgical procedure for treatment of end stage heart failure. Due to organ shortage an increasing number of patients is bridged to HTx by implantation of a mechanical circulatory support (MCS) system. The aim of this retrospective study was to identify wether MCS prior to HTx influences the time point of onset of coronary allograft vasculopathy. Methods: Medical records of heart transplant recipients transplanted between 1998 and 2008 surviving transplantation for at least one year were screened for onset of coronary allograft vasculopathy retrospectively. Annual coronary angiograms were analysed with regard to vasculopathy. Results: Overall 244 patients were included into the study and 1112 coronary angiograms were screened. Among these patients 58 (23.2%) were bridged with a MCS system. Mean survival was not different between bridged and non bridged patients (134.2 ± 9.2 vs. 156.4 ± 5.7 months, p = 0.117). Mean duration until onset of first lesion was not statistically different between the two groups (134.2 ± 9.2 vs. 156.4 ± 5.7 months, p = 0.117). Patients with onset of coronary allograft vasculopathy within the first 48 months after transplantation had a significantly shorter long-term-survival than those with later onset of coronary allograft vasculopathy (149 ± 11 vs. 190 ± 7 months; p = 0.02). However this did not differ between bridged and non bridged patients. Conclusion: Onset of coronary allograft vasculopathy within the first 48 months after transplantation is associated with impaired long-term-survival. However MCS prior to HTx had no influence on survival or onset of allograft vasculopathy.