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

Abstract

<h3>Purpose</h3> Tricuspid valve regurgitation (TVR) is often observed after orthotopic heart transplantation. However, there is a scarcity of data regarding long-term outcomes of patients with tricuspid valve regurgitation. Our aim was to compare alterations in TVR and its influence on long-term mortality. <h3>Methods</h3> 160 patients that underwent orthotopic heart transplantation between January 2008 and December 2015 at our center were included. TVR trends and associated clinical parameters were retrospectively analyzed. Mean follow-up time was 8.49±3.78 years (Median 9,27 years, Q1 6.40, Q3 11.50 years). TVR was assessed after 30 days, one, three and five years and groups were defined according to changes in TVR grade: constant (group 1, n=97), improvement (group 2, n=23) and deterioration (group 3, n=40). Survival, outcome with regards to operative technique, as well as, long-term kidney and liver function during follow-up were assessed. <h3>Results</h3> Overall mortality was 34.4%, with significant differences between the groups (p= 0.008). Mortality in group 1 was 35.7%, in group 2 8.7% and in group 3 46.2%. Cox-regression analysis revealed improvement of TVR as a significant predictor for survival (HR 0.078 CI 95% 0.011-0.567 p=0.012). Despite significant differences in survival analysis (long-rank p=0.007) deterioration of TVR did not reach statistical significance in a regression analysis. (p= 0.069). After 30 days 5% of the patients showed severe TVR. After one year 2.7% of the patients, after three years 2.9% and after five years 2.5% of the patients still showed severe TVR. Creatinine levels after 3 years showed significant differences between the groups (p= 0.047), deterioration of TVR being associated with higher creatinine levels in long-term follow-up. <h3>Conclusion</h3> Improvement of TVR may function as a positive predictor for long-term survival after orthotopic heart transplantation. Therefore, trends of TVR need to be monitored closely in echocardiographic examination during follow-up. The need for intervention of the tricuspid valve in heart transplant patients requires further investigation, since outcomes of patients with constant TVR and deterioration of TVR do not differ significantly.