Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Llong-term Outcome of Tricuspid Valve Surgery - PowerPoint PPT Presentation

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Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Llong-term Outcome of Tricuspid Valve Surgery

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Title: Risk Factors for Development of Tricuspid Regurgitation after Heart Transplantation and Llong-term Outcome of Tricuspid Valve Surgery


1
Risk 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
2
Background
  • 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.

3
Patient 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

4
Overall survival post-transplantation
5
No significant differences
Perioperative transplantation data of recipients
and donors
6
Significant differences
Number of biopsies
Number of rejections
7
Clinical status
  • Signs of right heart failure

8
Data 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.

9
Operative 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)

10
Number of Biopsies after Heart Transplantation Deu
tsches Herzzentrum Berlin 1986 2012 18,471 heart
biopsies
n
11
Tricuspid 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

12
Outcome 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)

13
Survival after TV Surgery
14
NYHA Functional Class after tricuspid valve
surgery
15
Conclusions
  • 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.

16
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