title: Tricuspid valve replacement after cardiac transplantation.
abstract: BACKGROUND
  Tricuspid valve insufficiency (TI) is common after orthotopic heart transplantation. However, tricuspid valve replacement or repair (TVR) is rare. The aim of this study is to evaluate our experience with TVR in cardiac transplant recipients.
  
  
  METHODS
  The Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program database was queried for TVR in all adult and pediatric heart transplant recipients. Pre-operative parameters and cardiac hemodynamics were compared with post-operative findings.
  
  
  RESULTS
  Since 1985, we identified in our database 17 patients who had 16 TVR, and 2 tricuspid valve repair procedures. Thirty-four heart transplant recipients from the same period were used as controls. The indication for TVR was symptomatic right heart failure (RHF) in 89% of cases, and there was no significant difference between the control group and the surgery group in the average number of biopsies. A flail leaflet was found in 16 cases (89%). One patient died post-operatively due to cardiogenic shock, and 1 patient died 8 months after TVR due to progressive RHF. Improvement in heart failure symptoms was seen in 12 cases. The central venous pressure (CVP) decreased from 17.8 +/- 4.1 mm Hg to 11.0 +/- 7.3 mm Hg (p = 0.013). There was no significant change in cardiac output or renal function. However, the furosemide dose decreased significantly from 47.69 +/- 56.44 mg/day to 26.54 +/- 46.43 mg/day (p = 0.009).
  
  
  CONCLUSIONS
  After orthotopic heart transplantation, TVR is a safe and effective procedure to alleviate RHF symptoms. Flail leaflets are the most common operative finding, suggesting that biopsy-induced trauma is the likely cause of severe TI in these patients.
authors.affiliation: Cardiology Division, University of Utah Health Sciences Center, Salt Lake City, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.forename: Feras
authors.initials: F
authors.lastname: Bader
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Hammond
authors.forename: Shreekanth V
authors.initials: SV
authors.lastname: Karwande
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Donald B
authors.initials: DB
authors.lastname: Doty
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hagan
authors.forename: Heidi
authors.initials: H
authors.lastname: Thomas
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*