*Purpose: Cardiac allograft vasculopathy (CAV) is one of the major factors limiting long-term survival after HTx. The use of angioplasty and drug-eluting stents is common after HTx. CAV of the left main (LM) coronary artery is known to have high mortality risk. The long-term outcome of stenting for LM disease has not been well evaluated in this cohort of patients.

*Methods: Between 2010 and 2013 we assessed 37 heart transplant patients who underwent stenting of the LM coronary artery post-transplant. A non-left main (no LM disease with another coronary artery stented) population was included (n=27) for comparison. Outcomes included 5-year freedom from restenosis (≥50% stent stenosis) subsequent 5-year survival, subsequent 5-year freedom from any myocardial infarction, and subsequent 5-year freedom from further deterioration in left ventricular function by echocardiogram.

*Results: Subsequent 5-year freedom from restenosis and freedom from further deterioration in LV function was significantly lower in the LM stented group (see table). There was no difference in subsequent 5-year survival or freedom from myocardial infarction.

*Conclusions: Patients with left main stenting appear to be have acceptable survival after heart transplantation despite progression to a lower left ventricular function and more restenosis. Alternatives to treatment for significant LM disease such as coronary bypass surgery and re-transplantation are not practical options in this diffuse disease and scarcity of donor hearts.

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