Clinical Implications of Late Mitral Valve Regurgitation Appearance in the Follow-Up of Heart Transplantation

Abstract

Background Tricuspid regurgitation is frequently observed after orthotopic heart transplantation (OHT), in association with severe pulmonary hypertension. However, the incidence of left-sided valvular disease has not been addressed. Aim We analyzed the incidence and prognostic implications of left-sided valve disease in 141 patients after OHT. Methods Echocardiography was performed with every endomyocardial biopsy during the first year after OHT and every 6 months thereafter. Mitral regurgitation (MR) grade II or III was considered significant. Graft vasculopathy was assessed using coronary angiography. Results Eight patients (6%) developed significant left-sided valvular disease, namely, MR in 6 (4%) and aortic regurgitation (AR) in 2 (1.4%). The 2 cases with AR were diagnosed the first week after OHT, whereas significant MR was diagnosed at mean follow- up of 34 ± 6 months. Mean regurgitant orifice and volume were 34 ± 14 mm 2 and 41 ± 15 mL/beat, respectively. Patients with significant MR had experienced a greater number of acute rejection episodes ≥3A, (1.8 ± 1.7 vs 0.8 ± 1.05; P = .02) and were associated with allograft vasculopathy in 83% vs 6% among unaffected patients ( P = .0001). Four of 6 patients with significant MR died during follow-up (67%) and 1 of the living patients underwent reparative mitral valve surgery. The probability of survival using Kaplan-Meier curves was significantly lower when patients developed late significant MR (54% vs 76%; P = .0001). Conclusions The incidence of significant left-sided valvular disease after OHT was low. MR was associated with a higher degree of previous acute rejection, of graft vasculopathy, and mortality. The presence of moderate or severe MR of late appearance identified a group of OHT patients with poor outcomes.