Clinical significance of tricuspid valve dysfunction after orthotopic heart transplantation.
OBJECTIVE
Tricuspid regurgitation (TR) is common after heart transplantation (OHT), but its clinical relevance is undetermined. This study documents the clinical progress of patients with TR after OHT in relation to the severity of TR.


METHODS
We studied 238 transplant recipients who had survived for at least 12 months after OHT. Tricuspid regurgitation was graded clinically and by assessing regurgitant jet area. Recipients were divided into those with no TR Group 1 (n = 64), those with sub-clinical TR (TR absent clinically and regurgitant jet area <25%, Group 2 (n = 89), and those with clinical TR (with clinical TR or regurgitant jet area > or =25%, Group 3 (n = 85).


RESULTS
We found no significant difference among the groups in terms of age, or pre-operative events. At 12 months after OHT, mean right atrial and pulmonary artery pressures were higher in Group 3 than in Group 1 or Group 2 (p = 0.005 and 0.03, respectively). Right ventricular end-diastolic and end-systolic volumes were smaller for recipients in Groups 1 and 2 compared with those in Group 3 (p = 0.01 and 0.02). The annual development of renal impairment was 0.019 (95% confidence interval [CI], 0.014-0.029), 0.026 (95% CI, 0.022-0.62), and 0.613 (95% CI, 0.346-0.756) in Groups 1, 2, and 3, respectively (p = 0.02). At the most recent follow-up, mean New York Heart Association class for Group 1 was 1.4, for Group 2 was 1.7, and for Group 3 was 2.7 (p = 0.04).


CONCLUSIONS
The integrity of the tricuspid valve has a significant impact on long-term clinical progress of OHT recipients. Recipients with significant TR are more symptomatic and have poorer right-sided heart function compared with those with mild or no TR.
Aziz
Tarek M
TM
Cardiac Transplant Unit, Wythenshawe Hospital, Manchester, United Kingdom. tarekaziz55@hotmail.com
Saad
Rasheed A
RA
Burgess
Malcolm I
MI
Campbell
Colin S
CS
Yonan
Nizar A
NA
D000328:Adult; D009202:Cardiomyopathies / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects* / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D011184:Postoperative Period; D014262:Tricuspid Valve Insufficiency / Q000209:etiology* / Q000503:physiopathology; D016278:Ventricular Function, Right; D017725:Ventricular Pressure