Tricuspid Valve Regurgitation Immediately After Heart Transplant And Long-Term Outcomes

Overview

Journal Ann Thorac Surg

Publisher Elsevier

Specialties General Surgery
Pulmonary Medicine

Date 2018 Dec 12

PMID 30529215

Citations 11

Authors

Muath Bishawi

Giorgio Zanotti

Linda Shaw

Michael Mackenzie

Anthony Castleberry

Karsten Bartels

Jacob Schroder

Eric Velazquez

Madhav Swaminathan

Joseph Rogers

Carmelo Milano

Affiliations

Soon will be listed here.

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.

Citing Articles

Echocardiographic Evaluation of the Post-Heart Transplant Patient.

Karatasakis A, Kiamanesh O, Cheng R, Kirkpatrick J, Dudzinski D Curr Cardiol Rep. 2025; 27(1):63.

PMID: 40014294 DOI: 10.1007/s11886-024-02169-5.

Tricuspid regurgitation after heart transplantation: where innovation and intervention are in hibernation.

Alyaydin E, Gotschy A, Parianos D, Nagele M, Tudorache I, Flammer A Heart Fail Rev. 2025; .

PMID: 39945978 DOI: 10.1007/s10741-025-10494-2.

Tricuspid Regurgitation after Orthotopic Heart Transplantation: Trajectories and Association With Mortality.

Belani K, Brinker V, Fuller M, Cooter M, Schroder J, Mamoun N Clin Transplant. 2025; 39(1):e70062.

PMID: 39777932 PMC: 11706220. DOI: 10.1111/ctr.70062.

Management options of valvular heart diseases after heart transplantation: A scoping review.

Yilmaz O, Keenan N Turk Gogus Kalp Damar Cerrahisi Derg. 2024; 32(1):112-122.

PMID: 38545365 PMC: 10964309. DOI: 10.5606/tgkdc.dergisi.2024.25631.

Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplant.

Schumer E, Kotkar K, Masood M, Kaneko T, Damiano R, Pawale A JTCVS Tech. 2023; 21:106-108.

PMID: 37854829 PMC: 10580097. DOI: 10.1016/j.xjtc.2023.07.014.

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