title: Severity of intraoperative tricuspid regurgitation predicts poor late survival following cardiac transplantation.
abstract: BACKGROUND
  This study evaluates the significance of tricuspid regurgitation (TR) on long-term survival as detected by intraoperative transesophageal echocardiography at the time of orthotopic heart transplantation. Although significant (2+ to 4+) TR after orthotopic heart transplantation is rare, its influence on long-term survival is unknown, warranting further investigation.
  
  
  METHODS
  Between January 1992 and July 2001, 181 consecutive patients underwent orthotopic heart transplantation. Tricuspid regurgitation was graded by intraoperative transesophageal echocardiography after final separation from cardiopulmonary bypass in 130 of 181 patients (72%).
  
  
  RESULTS
  Although 80% (104/130) of patients had either no (0, n = 77) or trace (1+, n = 27) TR, 9% (12/130 patients) had mild (2+), 10% (13/130 patients) had moderate (3+), and 0.8% (1/130 patients) had severe (4+) TR. The severity correlated strongly with the presence of right ventricular dysfunction (p < 0.001). In a multivariate regression model, gender mismatch (p = 0.002) and right ventricular dysfunction (p < 0.001) were independent predictors for equal to or greater than mild (2+ to 4+) TR (p = 0.015). Although the degree of recipient pulmonary vascular resistance did not influence the grade (p = 0.600), higher pulmonary vascular resistance tended to increase the severity of TR in the setting of prolonged donor ischemic times (p = 0.054). Proportional hazards regression analysis demonstrated significantly decreased survival for patients with mild or greater (2+ to 4+) TR detected by transesophageal echocardiography at the time of transplantation (p < 0.001) and RV dysfunction (p = 0.023).
  
  
  CONCLUSIONS
  Even mild (> or = 2+) TR identified by transesophageal echocardiography at the time of orthotopic heart transplant predicts poor late survival, suggesting a possible role for concomitant tricuspid valve repair at the time of transplant. Whether or not tricuspid valve repair will improve long-term survival is unknown.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Anderson
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.forename: James D
authors.initials: JD
authors.lastname: Rawn
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: John A
authors.initials: JA
authors.lastname: Jarcho
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: James Chen-Tson
authors.initials: JC
authors.lastname: Fang
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Gilbert H
authors.initials: GH
authors.lastname: Mudge
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000367:Age Factors; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D020521:Stroke / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional; D018487:Ventricular Dysfunction, Left / Q000150:complications