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Ann Thorac Surg. 2019 May;107(5):1348-1355. doi: 10.1016/j.athoracsur.2018.10.065. Epub 2018 Dec 5.

Tricuspid Valve Regurgitation Immediately After Heart Transplant and Long-Term Outcomes.

Author information

1
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
2
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
3
Duke Clinical Research Institute, Durham, North Carolina.
4
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado.
5
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
6
Division of Cardiothoracic Anesthesia, Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.
7
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: carmelo.milano@duke.edu.

Abstract

BACKGROUND:

Tricuspid valve regurgitation (TR) is a common finding immediately after cardiac transplantation. However, there is a scarcity of data regarding its implication if left untreated on long-term outcomes and the role of early surgical repair.

METHODS:

We retrospectively reviewed the Duke University Medical Center transplant database from January 2000 to June 2012 and identified 542 patients who underwent orthotropic heart transplantation. Patients were excluded if they underwent surgical repair for TR during the transplant or if the transplant was part of a multiorgan transplant or redo heart transplantation. TR was assessed intraoperatively after weaning from cardiopulmonary bypass. Independent variables were grade of TR and changes in TR grade during follow-up. TR grades were classified as insignificant (none or mild) versus significant (moderate or severe). Survival and need for posttransplant valve repair during follow-up were assessed.

RESULTS:

Significant TR was detected in 114 patients (21%) after weaning from cardiopulmonary bypass, with no significant difference in preoperative recipient pulmonary vascular resistance. Significant TR was associated with increased maximum postoperative plasma creatinine (median [interquartile range], 2.2 [1.5 to 3.2] mg/dL vs 1.8 [1.4 to 2.6] mg/dL, p = 0.008), prolonged postoperative stay (median [interquartile range], 12 [9 to 21] days vs 10 [8 to 14] days; p < 0.001), and decreased adjusted survival. Significant TR regressed to insignificant in 91% of recipients by 1 year after transplant. Six recipients (1%) who had significant TR after cardiopulmonary bypass underwent delayed tricuspid valve repair for significant TR during follow-up.

CONCLUSIONS:

Significant TR is a common finding immediately after transplant and is associated with early morbidity and reduced adjusted survival. Most significant TR resolves by 1 year after transplant. Optimal algorithms for follow-up and treatment of significant TR after heart transplantation need to be defined.

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