Incidence Of Tricuspid Regurgitation Research Articles

Impact of new-onset atrial fibrillation on the incidence of tricuspid regurgitation: a call to attention.

Impact of new-onset atrial fibrillation on the incidence of tricuspid regurgitation: a call to attention.

Secondary tricuspid valve regurgitation after isolated aortic valve replacement: outcomes and predictors.

We sought to assess the evolution of secondary tricuspid regurgitation (TR) after isolated aortic valve replacement (AVR) and its impact on mortality and to identify possible clinical and echocardiographic predictors of persisting and new-onset TR (TR de novo) after isolated AVR. Clinical and echocardiographic data of 441 patients, consecutively operated for isolated AVR between January 2017 and January 2020, were retrospectively collected. Four time points were included: preoperative, discharge, 3-6 months and last available follow-up. We followed patients with at least moderate TR (TR ≥2) over time and monitored the impact on survival. Logistic regression analysis was performed to identify possible predictors of persistent TR and TR de novo. Median follow-up was 33 months. Incidence of TR ≥2 changed over the time points. Twenty-three percent of patients with preoperative TR ≥2 had persistent TR at 3-6 months follow-up, and this phenomenon was predicted by age at regression analysis. Preoperative TR ≥2 was associated with a 3-fold higher risk to die. At 3- to 6-month follow-up, 12% of patients developed TR de novo. At least moderate preoperative mitral regurgitation (≥2) was predictive of TR de novo. Patients with TR ≥2 undergoing isolated AVR had worse long-term survival, and this was particularly evident in the elderly. Older patients were also more prone to have persistent TR after AVR. Some patients developed TR de novo after isolated AVR, but this did not affect survival.

Tricuspid regurgitation worsening after transcatheter or surgical aortic valve replacement

Abstract Background Tricuspid regurgitation (TR) often occurs concomitantly with severe aortic stenosis. Post-operative worsening of tricuspid regurgitation has been observed after surgical and transcatheter aortic valve replacement (SAVR, TAVR) [1,2]. Purpose Pre-procedural severe tricuspid regurgitation has been shown to be a predictor of all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR) [3,4]. However, little is known about the incidence of worsening tricuspid regurgitation after SAVR and TAVR and the impact on post-procedural outcomes. This study aims to evaluate, characterize and compare the incidence of worsening TR after TAVR and SAVR. Methods Retrospective single-center study of patients undergoing Transcatheter and Surgical Aortic Valve Replacement for severe aortic stenosis between 2014 and 2020. Incidence of tricuspid regurgitation was noted on echocardiogram at baseline and 1 year after TAVR or SAVR. This study enrolled 430 patients in the TAVR group and 237 patients in the SAVR group. The SAVR group only included patients who underwent isolated SAVR without any other valve intervention. Patients with severe TR at baseline were excluded from the study. Progression of TR severity was defined as deterioration by at least 1 grade of severity compared to baseline on echocardiography. Multivariable logistic regression analysis was performed to identify associations with worsening TR. Results Mean age of TAVR patients was higher than the SAVR patients (79±9 vs 68±12 years, p<0.0001). TAVR patients also had a significantly higher EuroSCORE than the SAVR patients (8.0±7 vs 3.5±4, p<0.0001). TAVR group was more likely to have atrial fibrillation than the SAVR group (34% vs 24%, p=0.006). Baseline right ventricular dysfunction and right ventricular enlargement were significantly higher in the TAVR group compared to the SAVR group [9% vs 4%, (p=0.009) and 10% vs 6%, (p=0.04), respectively]. Progression of TR severity occurred in 21.8% (94/430) of TAVR patients and 31.2% (74/237) of SAVR patients. Majority of these patients progressed from absent TR to mild TR [13.2% (57) in TAVR group vs 19.8% (47) in SAVR group (p=0.02)]. 6.3% (27) of patients in the TAVR group and 8.8% (21) of patients in the SAVR group had mild to moderate worsening of TR (p=0.22). 1.63% (7) in the TAVR group and 2.1% (5) in the SAVR group had progression from moderate to severe TR (p=0.65). On multivariable analysis, SAVR (Odds ratio, 2.46 [CI, 1.6–3.7]) and age (Odds ratio, 1.03 [CI, 1.03–1.05]) were associated with worsening TR severity. Conclusions In this retrospective observational study, SAVR and age were found to be associated with worsening tricuspid regurgitation. Majority of these patients progressed from absent TR to mild TR after SAVR. Further studies are necessary to determine long term outcomes of worsening tricuspid regurgitation after TAVR and SAVR. Funding Acknowledgement Type of funding sources: None.

Распространенность трикуспидальной регургитации среди пациентов многопрофильного стационара

Tricuspid regurgitation (TR) is a widespread valvular heart disease. Most times life expectancy doesn’t depend on trace to mild degrees of TR. Tricuspid valve surgery is probably recommended for patients with moderate to severe TR because of their poor long-term outcomes. It is necessary to study TR in different patients. The aim of this work was to study the incidence of TR in general hospital and to investigate moderate to severe TR incidence rate. We analyzed 50.647 transthoracic echocardiograms (TTE) done in Federal State Governmental Establishment «Burdenko Main Military Clinical Hospital» of Russian Federation Defense Ministry in 2004–2019. The median age of patients was 56 years (age 54.23±17.95 years). We discovered 44.854 cases of TR. Moderate to severe TR was detected in 5.735 (11.3%) patients (age 68.11±14.42 years, M=71 years). In general hospitals TR can be found in 88% of patients. Patients with moderate to severe TR are older patients with progressive TR. Male patient with severe TR is often older than a female patient.

Tricuspid regurgitation associated with implantable electrical device insertion: A systematic review and meta-analysis.

Implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) lead placement may worsen or result in tricuspid regurgitation (TR). While the association between lead placement and the incidence of TR has been established, current understanding of this problem remains incomplete. This systematic review and meta-analysis sought to pool the existing evidence to better understand the occurrence and severity of TR associated with cardiac implantable electrical device (CIED) insertion. An electronic search was performed to identify all relevant studies published from 2000 to 2018. Overall, 15 studies were selected for the analysis comprising 4019 patients with data reported on TR development following ICD or PPM lead placement. Demographic information, perioperative clinical variables, and clinical outcome measures, including pre and postoperative echocardiographic TR grade changes, were extracted and pooled for systematic review. Mean patient age was 69 years [95% CI: 64.62-73.59], and 63% [95% CI: 57-68] were male. Devices implanted included ICD in 57% [95%CI: 43-70] and PPM in 41% [95%CI: 31-52]. The most common indications for pacemaker implantation were sick sinus syndrome in 22% [95% CI: 22-37] and AV block in 21% [95%CI:12-34. The commonest indications for ICD implantation were primary and secondary prevention of sudden cardiac death. Atrial fibrillation was present in 37% [95%CI: 28-46] and congestive heart failure in 15% [95%CI: 2-57]. Baseline distribution of TR grades were as follows: grade 0/1 TR in 89% [95%CI: 82-93], grade 2 TR in 8% [95%CI: 5-13], grade 3 TR in 2% [95%CI: 0-7] and grade 4 TR in 2% [95%CI: 1-4]. Post-procedure, grade 0/ 1 TR decreased to 68% [95% CI: 51-81] (p<0.01), grade 2 TR increased to 21% [15-28] (p<0.01), grade 3 TR increased to 13% [95%CI: 5-32] (p=0.02), and grade 4 TR increased to 7% [95%CI: 5-9] (p<0.01). ICD and PPM lead placement is associated with increased TR post-procedure. Further studies are warranted to evaluate changes in TR grade in the long term.

An Uptated View on the Approach to Tricuspid Regurgitation

The incidence of tricuspid regurgitation (TR) associated with left valvular disease is significant ranging from 8% to 35% of cases. , This is most common in conjunction with mitral valve disease but association with aortic valve pathology is not uncommon and frequently related to rheumatic valve disease and much rarer in association with degenerative mitral valve disease. In most cases, the tricuspid regurgitation is so called “functional”, in other words, secondary to dilatation of the annulus as a consequence of [...]

Echocardiographic Changes in Patients with Chronic Obstructive Pulmonary Disease in a Study of Indian Population

Background: Chronic obstructive pulmonary disease (COPD) is a significant risk factor of cardiovascularmorbidity and mortality including tricuspid regurgitation (TR), right ventricular hypertrophy (RVH), leftventricular dysfunction (LVD) and right atrial enlargement (RAE) among others. Echocardiography is arapid, non-invasive, and accurate method to evaluate cardiac functions and used to diagnose cardiac changesin COPD patients. This study aimed to assess the prevalence of echocardiographic changes in COPD patientsand its association with disease severity, duration of disease and smoking.Methods: Two hundred thirty four patients of COPD fulfilling the inclusion criteria coming to RespiratoryClinic and Medicine OPD of Assam Medical College and Hospital were recruited. They were evaluatedby echocardiography. Adjusted odd ratios (ORs) (adjusted to age, gender and BMI) with 95% CIs ofechocardiographic changes were computed for different stages of GOLD standard using multiple logisticregression with GOLD stage I as reference. Test for trend was done using chi-square test and statisticalsignificance was taken p-value&lt;0.01.Results: Most common echocardiographic finding was TR, which was present in 63.25% of cases, followedby RVH (56.84%), LVD (33.33%) and RAE (30.33%). Echocardiographic findings of TR, RVH and RAEincrease with GOLD stage progression of COPD (p-value&lt;0.01). Disease duration was correlated withechocardiographic findings of TR, RVH and RAE. A significant trend of change in LVDD was seen forsmoking status with severity of GOLD. The similar echocardiographic findings were RAE, RVH and LVD.Conclusions: Our study finds that echocardiographic examinations of TR, RVH, LVD and RAE are essentialfor early diagnosis of cardiac screening for COPD patients. The incidence of TR is more common as severityof COPD increases followed by RVH. There is a significant correlation between severity of COPD withechocardiographic findings of TR, RVH and RAE.

Prognosis and risk factors of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in children

Objective To investigate the incidence and prognosis of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects in pediatric patients as well as the risk factors of regurgitation occurrence or aggravation. Methods Clinical data of 1 108 patients who underwent percutaneous closure in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiaotong University from January 2011 to January 2017 was analyzed retrospectively, and the prognosis and risk factors of postoperative tricuspid regurgitation and aggravation were also analyzed. Results Mild tricuspid regurgitation occurred in 24 cases after surgery with the incidence of 2.1%.Among 5 cases with mild or above preoperative tricuspid regurgitation, the regurgitation was alleviated after surgery in 4 cases.No severe tricuspid regurgitation requiring surgical intervention occurred in any patient during follow-up.Univariate analysis showed that intervention time (P<0.05) and residual shunt (P<0.05) were risk factors for mild or above tricuspid regurgitation after intervention.Binary regression analysis indicated that the size of the occluder (mm) (OR=1.48, 95%CI: 1.13-1.90) and residual shunt (OR=6.53, 95%CI: 1.69-25.30) were risk factors for tricuspid regurgitation after intervention (all P<0.05). Conclusions There is a certain incidence of tricuspid regurgitation after transcatheter closure of perimembranous ventricular septal defects, but most tricuspid regurgitation do not need surgical intervention.The intervention time, size of occluder and residual shunt are risk factors of intraoperatively or postoperatively tricuspid regurgitation. Key words: Ventricular septal defects; Tricuspid regurgitation; Septal occlude device; Retrospective study

Progression of Tricuspid Regurgitation after Heart Transplantation with Concomitant Tricuspid Valve Annuloplasty

Purpose Tricuspid regurgitation (TR) is a significant complication after heart transplantation (HTx). Tricuspid valve annuloplasty (TVA) may be performed empirically at the time of transplant to prevent the development of TR and right ventricular failure. This study aims to investigate the long-term impact of TVA on incidence of TR and survival. Methods All patients transplanted between 1/2010 - 8/2018 were enrolled. At our institution, we routinely perform DeVega TVA during HTx. All echocardiograms post-HTx were evaluated. TR was classified into 5 groups: none, trace, mild, moderate and severe. The incidence of significant TR (moderate or severe) over time and the effect of TR on survival were evaluated. Echocardiograms were evaluated starting 3 months post-HTx. Results 248 patients underwent HTx in this period, and 243 who underwent concomitant TVA were included in this analysis (mean age 54 years, 76% male). During 3.0 ± 2.1 years follow-up, 22 (9.1%) of patients developed significant TR. In the TVA group, survival free of significant TR was 96.9% at 6-months, 94.3% at 1 year, 91.6% at 2 years, 90.8% at 3 years, 90.8% at 4 years, and 88.8% at 5 years (Figure 1A). 5-year survival among those who experienced significant TR was numerically lower, but not significantly different (70.7% vs 81.5%, p=0.24) (Figure 1B). Only 8 (3.3%) patients required permanent pacemaker implantation over a median of 51 days (IQR 14-522) following HTx. Conclusion Significant TR after HTx is common and progressively worsens despite concomitant TVA. The association of significant TR with long-term survival and the benefit of TVA require further evaluation. Tricuspid regurgitation (TR) is a significant complication after heart transplantation (HTx). Tricuspid valve annuloplasty (TVA) may be performed empirically at the time of transplant to prevent the development of TR and right ventricular failure. This study aims to investigate the long-term impact of TVA on incidence of TR and survival. All patients transplanted between 1/2010 - 8/2018 were enrolled. At our institution, we routinely perform DeVega TVA during HTx. All echocardiograms post-HTx were evaluated. TR was classified into 5 groups: none, trace, mild, moderate and severe. The incidence of significant TR (moderate or severe) over time and the effect of TR on survival were evaluated. Echocardiograms were evaluated starting 3 months post-HTx. 248 patients underwent HTx in this period, and 243 who underwent concomitant TVA were included in this analysis (mean age 54 years, 76% male). During 3.0 ± 2.1 years follow-up, 22 (9.1%) of patients developed significant TR. In the TVA group, survival free of significant TR was 96.9% at 6-months, 94.3% at 1 year, 91.6% at 2 years, 90.8% at 3 years, 90.8% at 4 years, and 88.8% at 5 years (Figure 1A). 5-year survival among those who experienced significant TR was numerically lower, but not significantly different (70.7% vs 81.5%, p=0.24) (Figure 1B). Only 8 (3.3%) patients required permanent pacemaker implantation over a median of 51 days (IQR 14-522) following HTx. Significant TR after HTx is common and progressively worsens despite concomitant TVA. The association of significant TR with long-term survival and the benefit of TVA require further evaluation.

Features of cardiac remodeling in Patients with Acute Coronary Syndrome Complicated with Rheumatoid Arthritis

Cardiovascular diseases are important factors to increased morbidity and mortality in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the effects of RA on cardiac remodeling in patients with acute coronary syndrome (ACS). Sixty-one patients with ACS complicated with RA (RA group) and 55 age- and sex-matched patients with ACS without RA (control group) were enrolled. We compared the parameters of laboratory and echocardiogram across the 2 groups. Levels of serum brain natriuretic peptide in patients with RA were significantly higher than control group. Prevalence of left ventricular hypertrophy (LVH), and LV diastolic dysfunction (E/A < 1) were significantly higher in the RA patients, while the LV ejection fraction (EF%) was significantly lower in RA patients. Incidence of tricuspid regurgitation and pulmonary regurgitation were significantly higher in ACS patients with RA than in the ACS patients without RA. In RA group, levels of serum high density lipoprotein cholesterol were negatively correlated with C reactive protein (CRP), EF% was also negatively correlated with CRP. The prevalence of LVH and mitral regurgitation showed positive correlations with ESR. Early intervention for controlling the inflammation associated with RA can play a significant role in preventing cardiac remodeling in ACS patients.

Tricuspid valve interventions in 2015.

When the incidence of tricuspid regurgitation is taken into account, along with its impact on functional status and long-term survival, tricuspid regurgitation is currently undertreated. Today, though transcatheter therapy of aortic, mitral- and pulmonic valve disease is well established, interventional treatment of tricuspid valve disease is still in its early stages. Currently, various promising devices are in different stages of development, but it is still too early to clarify which interventional approach in the future might result in functional and clinical success. Similarly, it is yet unclear which type of patient subpopulation will benefit from this type of treatment. Seen in the current context of the overall evolution in the adoption of catheter-based treatments for other types of structural heart disease, the need for and interest in effective interventional treatments for tricuspid regurgitation is growing.

Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing

This study aimed at comparing the development of tricuspid and mitral regurgitation between the right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing. We prospectively enrolled 164 patients for permanent pacemaker implantation due to sick sinus syndrome or atrioventricular block and randomly divided them into two equal groups to receive either RVOT or RVA pacing. Patients with heart failure or valvular disease were excluded. The post-procedural echocardiographic evaluations were performed 1year after the pre-procedural echocardiography, and the results were compared with respect to the development of mitral and tricuspid regurgitation and probable changes in the ejection fraction (EF). Age, gender, pacing mode, and baseline cardiac rhythm did not significantly differ between the RVOT and RVA pacing groups. The incidence of mitral regurgitation was significantly higher in the RVA group (p = 0.03), but the incidence of tricuspid regurgitation was similar in both groups. There was a trend toward less tricuspid regurgitation in the RVOT group; however, it was not statistically significant. The mean EF was not significantly different between the study groups. It seems that the incidence of mitral regurgitation in RVA pacing is significantly higher than that in RVOT pacing. The formation of tricuspid regurgitation needs to be discussed in the future. IRCT201103146061N1.

Incidence of tricuspid regurgitation and the total number of tricuspid valve surgery in patients with mitral valve disease at Clinical Hospital Center Osijek

Incidence of tricuspid regurgitation and the total number of tricuspid valve surgery in patients with mitral valve disease at Clinical Hospital Center Osijek

473 Echocardiographic Guidance for Endomyocardial Biopsy Reduces the Incidence of Tricuspid Regurgitation Post Cardiac Transplantation

Endomyocardial biopsy (EMB) remains the mainstay of surveillance for rejection after cardiac transplantation. However, the incidence of tricuspid regurgitation (TR) and the need for tricuspid valve replacement (TVR) post cardiac transplantation remains a concern. The purpose of this study was to assess the impact of combined echo and fluoroscopic imaging during EMB on the severity of TR and need for TVR post transplant.

Bioprosthetic Tricuspid Valve Regurgitation Associated With Pacemaker or Defibrillator Lead Implantation

The goal of this study was to determine the impact of transvenous pacemaker and defibrillator leads on the incidence of bioprosthetic tricuspid valve (BTV) regurgitation compared with BTV patients without a transvalvular lead. Although concern has been raised regarding the potential deleterious effect of permanent transvenous device leads on BTV function, little is known about the incidence of prosthetic tricuspid regurgitation (TR) after lead placement. A retrospective review of 58 patients who underwent BTV implantation and subsequently required endocardial pacemaker (n = 52) or defibrillator (n = 6) lead implantation across the BTV was conducted. Patient and prosthesis characteristics, lead type, and clinical events were collected. The incidence and severity of prosthetic TR, determined by Doppler echocardiography, was compared with 265 consecutive patients who underwent BTV implantation without undergoing subsequent transvalvular device lead implantation. Over a mean follow-up of 25 months, in 5 patients (9%) with a transvalvular lead significant (moderate or greater) prosthetic TR developed compared with 12 patients (5%) in the control group (p = 0.20). Kaplan-Meier analysis revealed no significant difference in the incidence of TR in BTV patients with and without transvalvular leads (p = 0.45). Significant prosthetic TR in patients with and without a transvalvular lead more commonly occurred 2 years or later after lead or BTV implantation (4 of 5, 80% and 10 of 12, 83%, respectively). Transvalvular device lead implantation in BTV patients was not associated with an increased incidence of significant prosthetic TR (p = 0.45). Based on these data, transvalvular lead implantation appears to be an acceptable approach for patients with a BTV who require permanent pacemaker or defibrillator placement.

Abstract 8803: Bioprosthetic Tricuspid Valve Regurgitation Associated with Device Lead Implantation

Background Little is known about the effects of permanent transvenous device leads on bioprosthetic tricuspid valve (BTV) function. Hypothesis The goal of this study was to test the hypothesis that transvalvular device leads promote clinically significant BTV regurgitation. Methods A retrospective review of 58 patients who underwent BTV implantation and subsequently required endocardial pacemaker (n=52) or defibrillator (n=6) lead implantation through the BTV was conducted. Patient and prosthesis characteristics, lead type, and clinical events were collected. The incidence and severity of prosthetic tricuspid regurgitation (TR), determined by Doppler echocardiography, was compared to 265 patients who underwent BTV implantation without undergoing subsequent transvalvular device lead implantation. Results Over a mean follow up of 25 months, 5 patients (9%) with a transvalvular lead developed ≥ moderate prosthetic TR compared to 12 patients (5%) in the control group (P = 0.20). Kaplan Meier survival analysis revealed no significant difference in the incidence of TR in BTV patients with and without transvalvular leads (p = 0.45). Clinically significant prosthetic TR in patients with and without a transvalvular lead more commonly occurred 2 years or later after lead implantation or BTV implantation (4/5, 80% and 10/12, 83%). Conclusions Compared to BTV controls, there was no significant difference in the incidence of ≥ moderate prosthetic TR in patients with a transvalvular pacemaker or defibrillator lead (p = 0.45). Transvalvular lead implantation appears to be an acceptable approach for patients with a BTV who require permanent pacemaker or defibrillator placement.

580 Evaluation of the Role of a Long Sheath for Endomyocardial Biopsy Following Heart Transplantation on the Incidence of Tricuspid Regurgitation

In the first 12 months following heart transplantation it is standard practice to perform a schedule of endomyocardial biopsies (EMBx) to detect allograft rejection. The commonest cardiac complication of this procedure is tricuspid regurgitation (TR), which is thought to reflect damage to tricuspid valve leaflets or sub-valvular apparatus by the bioptome during its repeated passage across the tricuspid valve. At our institution, we have adopted the use a long sheath which sits directly in the right ventricle to guide the bioptome and avoid repeatedly crossing the tricuspid valve.

Immediate- and medium-term effects of balloon pulmonary valvuloplasty in infants with critical pulmonary stenoses during the first year of life: A prospective single center study

Background Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary stenosis (PS) irrespective of their age. Nevertheless neonates and infants with critical PS represent a high-risk group that needs to be studied. Methods The study population included 72 infants with severe congenital valvular PS and four infants with imperforate pulmonary valve (PV) who were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, Chest roentgenogram and transthoracic echocardiography. BPV was attempted in all infants with a peak-to-peak gradient across the PV of 50 mmHg or greater at catheterization-laboratory. Full echocardiographic evaluation was done 24 hours after the procedure as well as 3 and 6 months later. Results Seventy-six infants with severe PS or imperforate PV with a mean age of 5.63 ± 2.99 months were subjected to BPV with or without wire perforation. Immediately after the procedure patients had a significant reduction of the right ventricular systolic pressure (RVSP) (104.69 ± 24.98 mm Hg Vs 43.6 ± 13 mm Hg, p < 0.001) and RV-PA systolic pressure gradient (PG) (82.5 ± 23.76 mm Hg Vs 17.35 ± 8.96 mm Hg, p < 0.001). The immediate success rate defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement was achieved in 85% of the cases. There was a progressive drop in the PG across the PV by Doppler echocardiogram throughout a follow-up period of six months from a mean of 93.3 ± 28.2 mm Hg to a mean of 17.4 ± 10.42 mm Hg ( p < 0.001). There was a significant increase of the mean PV annulus diameter after balloon dilatation ( p < 0.001). There was also a highly significant inverse correlation between the growth of the pulmonary annulus and the annular size at the baseline before dilatation ( r = −0.74, p value <0.001). The incidence of PR significantly increased immediately after BPV to 64% followed by a progressive decline over a 6 months period of follow-up to 20%. There was a significant decrease in the incidence of tricuspid regurgitation (TR) over the same period of follow-up (from 55.6% at baseline to less than 20% at follow-up). Conclusion BPV is safe and effective to relieve critical PS in infants during the first year of life. The balloon promotes advantageous changes in both, pulmonary annulus and PG across the RVOT. In addition, the Doppler gradient observations during the follow-up support the expectation that BPV is a “curative” therapy.

Tricuspid Regurgitation after Orthotopic Heart Transplantation

Tricuspid regurgitation (TR) is a relatively common abnormality in normal adults as well as after orthotopic heart transplantation (OHT). A few studies have shown reduction in the incidence of TR after OHT by total bicaval surgical anastomosis technique. Other studies reported no significant difference in the rates of TR between the standard and bicaval techniques. Evaluate and compare the degree of TR after OHT by standard and bicaval anastomosis techniques. Echocardiograms from the first 56 consecutive patients that had the total bicaval surgical technique performed were retrospectively reviewed and compared with the last 57 consecutive patients who had the standard biatrial technique performed. Patients with adequate two-dimensional and Doppler echocardiograms were included. No statistical difference was observed for each grade of TR at both early and late time points. No significant difference was observed between the TR velocities of both biatrial and bicaval anastomosis patients at different periods. There appears to be no difference between the TR severity and TR velocity at early and late time points regardless of anastomotic technique.

Updates in Heart Transplantation

Heart transplantation (HTx) has been a successful therapy for patients with end-stage heart failure. Since 1987, we have performed 288 HTx. Thirty-six subjects needed mechanical support prior to HTx. We use anti-thymocyte globulin (ATG) as induction therapy and low-dose immunosuppressive agents for maintenance treatment. In June 1996, we performed combined heart and kidney transplantation after bridging for 14 days with an indigenous total artificial heart (TAH). The patient is still well. Our actuarial survival rates at 1, 5, and 10 years are 86%, 76%, and 61%, respectively. One recipient who voluntarily discontinued all treatment at 4 years after HTx is still alive and free of rejection in his ninth posttransplantation year. The longest surviving recipient is in her 18 th posttransplantation year. We also have used many suboptimal donor hearts, most with satisfactory outcomes. A 14-year-old boy had full recovery of heart function after receiving a donor heart after 13 hours of ischemia in 2003. Standard biatrial anastomotic technique is still our first choice. The incidence of tricuspid regurgitation (TR) and conduction disturbances is not higher than the bicaval technique reported by others. With low-dose therapy, our short-term and long-term results of HTx are satisfactory. The use of suboptimal donor hearts may expand the donor pool and save more patients' lives. A biatrial anastomosis remains our surgical technique.