Restoring Coronary Vasomotion in Pediatric Cardiac Allograft Vasculopathy

BACKGROUND: Percutaneous coronary interventions in cardiac allograft vasculopathy (CAV) remain challenging. In CAV, diffuse neointimal proliferation contributes to progressive allograft dysfunction and increased mortality. Although second-generation drug-eluting stents are widely utilized, permanent vessel caging may limit adaptive remodeling, resulting in target lesion failure. Drug-eluting coronary bioadaptors have been designed to provide vessel support while enabling restoration of physiological vasomotion. CASE SUMMARY: We report the case of a 15-year-old male patient with CAV, 4 years after heart transplantation. A DynamX drug-eluting coronary bioadaptor was successfully implanted in the circumflex artery. At 20-month follow-up, coronary angiography and intravascular ultrasound demonstrated preserved vessel patency and compliance, with no evidence of target lesion failure. DISCUSSION: This case highlights the feasibility of bioadaptor-based percutaneous coronary interventions in a pediatric heart transplant recipient with CAV and supports further evaluation of this technology in patients with complex coronary lesions. TAKE-HOME MESSAGE: Bioadaptors may provide acute vessel support while allowing dynamic vessel motion after uncaging in CAV.