title: Tricuspid valve replacement after cardiac transplantation.
abstract: BACKGROUND
  Tricuspid regurgitation (TR) occurs commonly in transplanted hearts. Although theoretically attractive, tricuspid valve replacement (TVR) has not been widely investigated as a possible therapy in post-transplant patients. The purpose of this study was to determine the safety of TVR in heart transplant patients and its effects on measurable clinical endpoints.
  
  
  METHODS
  We acquired data by both retrospective chart review and prospective data collection in all patients who underwent TVR after cardiac transplantation.
  
  
  RESULTS
  Nine patients were identified and followed for a period of six months. The age of patients at time of TVR was 62 +/- 6.1 yr and their average time since transplantation was 12 +/- 3.2 yr. Most patients demonstrated a reduction in their furosemide dose (105 +/- 63 mg/d pre-TVR vs. 67.5 +/- 65 mg/d post-TVR, p = 0.001) with a reduction in serum creatinine levels (188 +/- 72 micromol/L pre-TVR vs. 143 +/- 42 micromol/L post-TVR, p = 0.06). Additionally, we found a significant improvement in albumin values (32 +/- 5 g/L pre-TVR vs. 42 +/- 3 g/L post-TVR, p = 0.002) as well as an improvement in total bilirubin (35 +/- 18 micromol/L pre-TVR vs. 18 +/- 5 micromol/L post-TVR, p = 0.05). There was only one death in our series, in the only patient with known severe graft atherosclerosis.
  
  
  CONCLUSIONS
  TVR appears to be a safe procedure in patients without severe graft atherosclerosis with improvements in serum creatinine, albumin and total bilirubin values, in addition to a reduction in furosemide dose. This may reflect improved forward flow, improved symptomatology from TR as well as possible beneficial effects on nutritional status.
authors.affiliation: Heart Failure and Heart Transplant Centre, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ramya
authors.initials: R
authors.lastname: Raghavan
authors.forename: Renzo
authors.initials: R
authors.lastname: Cecere
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
authors.forename: Nadia
authors.initials: N
authors.lastname: Giannetti
mesh_terms: D004452:Echocardiography; D005500:Follow-Up Studies; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*