Cardiac allograft vasculopathy (CAV)

Cardiac allograft vasculopathy (CAV) is a condition that affects transplanted hearts. It causes the blood vessels supplying blood to the heart muscle itself to become narrowed and eventually blocked. It is a result of your immune system affecting the transplanted heart but other factors like a high cholesterol, diabetes, and smoking can contribute.

CAV affects around half of transplanted hearts within the first 10 years. It is one of the main conditions that limit long term survival after a heart transplant.

 CAV can cause symptoms such as:

• Breathlessness
• Chest pain
• Palpitations

However, most patients have no symptoms until the disease is severe.

CAV is thought to be caused by the immune system interacting with the donor heart and is sometimes referred to as a form of ‘chronic rejection’.

Maintaining a healthy lifestyle following a heart transplant is an important factor in preventing the development of CAV.

This includes:

• Keeping to a healthy diet
• Undertaking regular exercise
• Not smoking
• Maintaining a healthy body weight
• Take your medications as prescribed

Learn more about staying healthy after a heart transplant

A key focus of clinic visits in the longer term will be working with the transplant team to ensure good blood pressure, blood sugar and cholesterol control.

It is important to take your immunosuppressant medicines as prescribed.

A group of medicines known as statins have been shown to reduce the amount of heart artery narrowing when started early after transplantation, even when a person’s cholesterol levels are normal. They are therefore recommended to all people who receive a heart transplant.

A test known as coronary angiogram can be performed to look at the blood vessels of the heart in more detail. It involves placing a fine tube into an artery that supplies the heart muscle and injecting a special dye whilst taking x-ray pictures.

Alternative tests, such as CT or MRI scans, may also be considered.

Blood vessel narrowing and blockages can sometimes be opened with metal tubes, known as stents, and this may help to relieve symptoms. However, in transplanted hearts, the narrowing often affect the smaller blood vessels feeding into the heart, making it more difficult to treat with stents or heart bypass surgery. Repeat transplantation may be considered in a few patients with severe disease, however, this is not a common option.