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

Tricuspid Valve Regurgitation After Heart Transplantation: A Single-Center 10-Year Experience

“…In a large recent study about tricuspid regurgitation after heart transplantation, Bishawi and colleagues found that independent predictors of moderate and severe tricuspid regurgitation were high donor creatinine, the male recipient and sex mismatch [ 2 ]. We found that dilated cardiomyopathy was significantly associated with moderate or severe postoperative tricuspid regurgitation, which could be attributed to the size mismatch between donor and recipient hearts.…”

“…Veen and associates in their larger series found that 33% of the patients had moderate to severe TR after transplant, and it declined to 15% after 5 years; however, mortality was significantly higher in patients with moderate to severe TR [ 11 ]. Bishawi and coworkers found that survival is significantly decreased in patients with moderate and severe tricuspid regurgitation after adjusting for recipient pulmonary vascular resistance, donor and recipient creatinine, ischemia time, donor age, sex mismatch, and body mass index [ 2 ]. Another study found that more than mild tricuspid regurgitation was an independent predictor of mortality [ 12 ].…”

“…The outcomes of heart transplantation had improved recently with the introduction of the new immunosuppressive agents [ 1 ]; however, several risk factors are still affecting the long-term outcomes. The problem of tricuspid regurgitation of the donor's heart is still debatable, and there is no consensus on the concomitant management of the tricuspid valve during a heart transplant [ 2 ]. Prophylactic tricuspid valve annuloplasty for all patients undergoing heart transplants may not be practical nor cost-effective, and high-risk patients who could benefit from this intervention are not known [ 3 ].…”

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

“…151 Tricuspid Regurgitation (TR). In a cohort of 542 heart transplant recipients at Duke University, Bishawi et al 152 retrospectively examined the incidence and severity of TR immediately after heart transplant and outcomes. Significant (moderate or severe) TR was present immediately after separation from CPB in 21% of patients and was associated with adverse outcomes, including higher postoperative creatinine, prolonged postoperative stay, and decreased adjusted survival.…”

“…Romeo et al 145 AKI stage III affects both early and late mortality Independent risk factors associated with development of severe AKI: older age, increased SCr at baseline, and increased PVR at baseline Garcia-Gigorro et al 146 Patients with AKI had a greater hospital mortality Main risk factors associated with AKI: cardiac tamponade, acute right ventricular failure, and major bleeding Kolsrud et al 147 Risk factors associated with RRT: previous heart surgery, preoperative ventricular assist device, and a lower mGFR at baseline Primary graft dysfunction (PGD) Bishawi et al 152 Moderate or >TR was present in 21% of HT recipients on intraoperative TEE and was associated with adverse outcomes but resolved in 91% of cases Greenberg et al 153 Prophylactic donor tricuspid annuloplasty was not associated with benefit or harm Immunosuppression Bakir et al 154 Patients cluster into different phenotypes with regard to immunosuppressionrelated complications, with event rates linked to quicker tapering of immunosuppression Older recipients…”