Severity of intraoperative tricuspid regurgitation predicts poor late survival following cardiac transplantation.
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.
Anderson
Curtis A
CA
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Shernan
Stanton K
SK
Leacche
Marzia
M
Rawn
James D
JD
Paul
Subroto
S
Mihaljevic
Tomislav
T
Jarcho
John A
JA
Stevenson
Lynne W
LW
Fang
James Chen-Tson
JC
Lewis
Eldrin F
EF
Couper
Gregory S
GS
Mudge
Gilbert H
GH
Byrne
John G
JG
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