Natural History of Tricuspid Valve Regurgitation (TR) Diagnosed Immediately after Heart Transplant

Abstract

Purpose Tricuspid valve regurgitation is a common finding at time of cardiac transplantation. Optimal surgical management of TR in this setting is uncertain. Our objective is to assess the natural history of TR after transplant and identify the impact on postoperative morbidity and survival. Methods and Materials We retrospectively reviewed our transplant database from January 2000 to June 2012. TR was assessed with intraoperative TEE after graft reperfusion and postoperative TTE at monthly followups and yearly thereafter. TR grades were classified as insignificant (none, mild) vs. significant (moderate, severe). Survival, changes in TR grade and need for post-transplant valve repair were analyzed. Surgery for TR during transplant and combined/redo heart transplant were exclusion criteria. Results 542 transplants performed with bicaval technique had both intraoperative TEE after graft reperfusion and postoperative TTE available. Significant TR was detected in 21% after reperfusion despite no significant difference in preoperative mean PA and wedge pressures. Significant TR was associated with increased plasma creatinine (2.6±1.5 vs. 2.1±1.2 mg/dL, p=.008), prolonged postoperative stay (20 days, CI 9-21 vs. 14 days, CI 8-14 p Conclusions Significant TR immediately after transplant is a common finding and appears to be associated with early morbidity and reduced survival. The majority of significant TR resolves by 1 year post-transplant. Assessment of predictors of persistent significant TR after heart transplant is warranted. [ figure 1 ]