Tricuspid Valve Regurgitation after Orthotopic Heart Transplantation: Prevalence and Etiology

Abstract

Background. Tricuspid valve regurgitation (TR) after orthotopic heart transplantation (OHT) is common. The aims of this study were to determine the prevalence of TR after OHT, to examine the correlation between its development and various variables, and to determine its outcomes. Methods. All 163 OHT patients who were followed up between 1988 and 2009 for a minimal period of 12 months were divided into those with no TR/mild TR and those with at least mild-moderate TR, as assessed by doppler echocardiography. These groups were compared regarding preoperative hemodynamic variables, surgical technique employed, number of endomyocardial biopsies, number of acute cellular rejections, incidence of graft vasculopathy, and clinical outcomes. Results. At the end of the followup (average 8.2 years) significant TR was evident in 14.1% of the patients. The development of late TR was found by univariate, but not multivariate, analysis to be significantly correlated with the biatrial surgical technique (P < 0.01) and the presence of graft vasculopathy (P < 0.001). TR development was found to be correlated with the need for tricuspid valve surgery but not with an increased mortality. Conclusions. The development of TR after OHT may be related to the biatrial anastomosis technique and to graft vasculopathy.

Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

“…The exact etiology of TV regurgitation after OHT is unknown. Anastomotic technique, donor/recipient size characteristics, number of cellular rejections, and iatrogenic injury during endomyocardial biopsies have all been implicated (9). TR at the time of OHT has been shown to predict poor late survival, though it is unclear if TV interventions at the time of OHT will improve long-term outcomes (10).…”

Tricuspid valve regurgitation after heart transplantation

“…Multiple studies have shown that the majority of TVR that develops following heart transplantation does not lead to symptoms significant enough to warrant surgical repair (2,4,6). In the minority of patients, however, for whom TVR leads to medically refractory symptoms, repair and replacement options have been employed.…”

Tricuspid Valve Insufficiency in Recipients With Transplanted Heart

“…Berger et al провели сравнительный анализ результатов трансплантации сердца у пациентов, перенесших операцию, выполненную по биатриаль-ной и бикавальной методикам. В ходе исследования было выявлено, что у 65% реципиентов со средней и тяжелой степенью регургитации трикуспидального клапана была выполнена трансплантация по биатри-альной методике [29].…”

“…Berger et al в своем исследовании обнаружили статистически значимую корреляцию между высокой степенью легочной гипертензии в дооперационном периоде и развитием на трикуспидальном клапане регургитации после операции [29].…”

“…Berger et al в своем исследовании не обнаружи-ли положительной корреляции между количеством проведенных ЭМБ и увеличением степени обнару-жения недостаточности клапана [29].…”