Single Center Experience: Tricuspid Valve Insufficiency Resolution Post Lung Transplant

Abstract

Tricuspid valve regurgitation (TR) is a frequent finding in patients undergoing lung transplantation (LTx). The prognostic significance and rate of regression of TR after LTx are under reported. Purpose of this study is to assess tricuspid valve regurgitation (TR) regression after lung transplantation (LTx) in patients with trivial to severe pre-operative TR. We retrospectively reviewed and prospectively collected records of 553 patients who had LTx at our institution from 2001 to 2017. Pre and post-op echocardiograms were retrospectively reviewed and was graded for severity of TR, right ventricular (RV) enlargement, tricuspid annular plane systolic excursion (TAPSE), mean pulmonary arterial pressure (mPAP) and other hemodynamics. Continuous variables were summarized with median and range (min, max) while categorical variables with frequency and percent. All statistical analyses were performed with R Statistical Software (version 3.4.2; R Foundation for Statistical Computing, Vienna, Austria). The mean age of the patients was 64 (21.0, 82.0) years and 324 (58.7%) were males. Out of all patients, the majority 302 (55.8%) suffered from IPF, followed by 84 (15.3%) PH, 79 (14.3%) COPD, 65 (11.8%) emphysema, and 31 (5.6%) CF. 417 (75.4%) had double LTx and 136 (24.6%) of patients required single LTx . Pre-operative tricuspid valve regurgitation reported as trivial (N=265, 47.9%) mild (N=235, 42.5%), moderate (N=40, 7.3%) and severe (N=13, 2.3%). TR improved from pre to post operatively in 193 (34.9%) out of 553 patients (p<0.001), while 99 (17.9%) out of 553 resulted in a worsened TR. However, of the patients that had a worsened TR, 78 of them went from trivial to mild (N=99, 79%). 81.9% (158/193) improved by one category while 18.1% (35/193) improved by two or more categories. Of those with worsened TR, the majority or (92.9%) (92/99) worsened by one category and 7% (7/99) worsened by two categories. There was a significant improvement from moderate/severe TR to mild, trivial, or none (p<0.001) 44 (N=53, 83%). There was also a significant decrease in mPAP (median: 27 (10-84) vs. 24 (9-89) p<0.001). Moderate to severe TR significantly improved after lung transplant. Our findings suggest that preoperative TR in lung recipients is mostly functional and will resolve after LTx. There is no need for tricuspid valve repair at the time of transplantation.