Title: Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Llong-term Outcome of Tricuspid Valve Surgery
1Risk Factors for Development of Tricuspid
Regurgitation after Heart Transplantation and
Long-term Outcome of Tricuspid Valve Surgery
Roland Hetzer Anja Claudia Baier Eva Maria Delmo
Walter
29 April 2015
2Background
- Tricuspid valve regurgitation has been observed
as a postoperative complication after orthotopic
heart transplantation. - Its incidence has been reported at a rate up to
84. - During the last 20 years, it has been attributed
to biatrial anastomosis technique hence the
bicaval anastomosis technique has been preferred
and become routine. - In our experience, tricuspid regurgitation has
remained infrequent even with biatrial
anastomosis.
Objectives
- This report aims to identify predisposing
factors which promote the development of
tricuspid regurgitation (TR) after heart
transplantation. - Likewise, it aims to evaluate outcomes of
tricuspid valve surgery for post-transplant TR.
3Patient Selection
Between 1986 and 2013 1804 heart
transplantations on 1748 patients
1552 heart transplantation performed with
biatrial anastomosis 252 heart transplantations
with bicaval anastomosis
86 patients developed TR III/IV
55 patients medically managed successfully
31 patients underwent TV surgery All had heart
transplantation with biatrial technique
1 patient was lost to follow-up
- Group II Control
- 30 patients matched for
- Underlying disease
- Age
- Gender
- Anastomosis
- Transplantation date
- TR 1
Group I 30 patients Tricuspid valve surgery
- Comparison
- Perioperative data
- Echo results
- Clinical performance
- Catheter findings
Follow up after TV-surgery
4Overall survival post-transplantation
5No significant differences
Perioperative transplantation data of recipients
and donors
6Significant differences
Number of biopsies
Number of rejections
7Clinical status
- Signs of right heart failure
8Data of 30 patients who underwent tricuspid valve
surgery
- TR III-IV was diagnosed at a median of 6.86
(0.3-20.9) years after heart transplantation. - Tricuspid valve surgery was performed at a median
of 1.64 (0-15.6) years after diagnosis.
9Operative data of 30 patients who underwent
tricuspid valve surgery
- Leaflet and chordal damage were found in 25/30
patients (1 with TV endocarditis) - Annular dilatation/distortion in 5/30
- Concomitant procedures
- coronary bypass graft (n6)
- pulmonary lobe resection (n2)
- coronary fistula closure (n2)
- VSD closure (n1)
- Mitral valve replacement (n1)
10Number of Biopsies after Heart Transplantation Deu
tsches Herzzentrum Berlin 1986 2012 18,471 heart
biopsies
n
11Tricuspid valve surgery
- Mechanical valve replacement in 8/30
- Xenograft valve replacement in 7/30
- Reconstruction in 15/30
- Modified deVega annuloplasty 8
- Double orifice valve 3
- Kay Wooler annuloplasty 1
- Cosgrove Edwards ring 1
- Chordal and leaflet repair 2
12Outcome of tricuspid valve surgery
- In-hospital deaths n6 (20)
- after TV replacement (2 mechanical, 2 xenograft)
and TV repair - Causes of death
- cardiac failure (2), sepsis
(3), myocardial infarction (1) - One retransplantation on the 1st postop day after
mechanical valve replacement and coronary bypass
grafting.
- Renal function improved in 3 patients and
deteriorated in 9 - Significant improvement of edema and ascites
after 1 year - Median postoperative survival was 3.47 years (3d
- 20.2yrs) - Recurrent TR gt II was seen in 6 (4 repair and 2
replacement) - Long term complications
- mechanical valve thrombosis (n1),
- xenograft valve endocarditis (n1)
13Survival after TV Surgery
14NYHA Functional Class after tricuspid valve
surgery
15Conclusions
- The number of biopsies and rejections were the
only predisposing factors for TR after heart
transplantation in this series. - There was a very low incidence of TR which could
be attributed to distortion of TV geometry in
biatrial anastomosis. - Tricuspid valve surgery improves symptoms of
right heart failure. - Early mortality is high, but long-term survival
has been observed.
16Thank you for your attention!