title: Donor tricuspid annuloplasty during orthotopic heart transplantation: long-term results of a prospective controlled study.
abstract: BACKGROUND
  Development of tricuspid regurgitation after orthotopic heart transplantation can cause heart failure along with renal and hepatic impairment and portends a poor prognosis. If tricuspid regurgitation causes significant symptoms, tricuspid valve repair or replacement is often required. This study was designed to study the effects of prophylactic tricuspid valve annuloplasty (TVA) during orthotopic heart transplantation on long-term survival, renal function, and amount of tricuspid regurgitation.
  
  
  METHODS
  Between April 1997 and March 1998, 60 patients (aged 18 to 70 years; 22 female) randomly received either standard bicaval orthotopic heart transplantation (group STD; n = 30) or bicaval orthotopic heart transplantation with DeVega TVA (group TVA; n = 30). Tricuspid valve annuloplasty was performed on the donor heart before implantation using pledgeted 2-0 polypropylene and sized to an annulus of 29 mm. Echocardiographic measurements, laboratory values, and hemodynamics were obtained prospectively and reviewed by an independent data analyst.
  
  
  RESULTS
  Follow-up of patients as of December 2003 was complete. Although there was a perioperative mortality advantage in group TVA, there was no difference between groups in long-term survival. At the end of the study, however, there was a statistical difference (group STD versus group TVA, p < 0.05) with regard to cardiac mortality (7 of 30 versus 3 of 30), average amount of tricuspid regurgitation (1.5 +/- 1.3 versus 0.5 +/- 0.4), percentage of patients with 2+ or greater tricuspid regurgitation (34% versus 0%), serum creatinine (2.9 +/- 2.0 versus 1.8 +/- 0.7), and difference in serum creatinine over baseline (2.0 +/- 2.1 versus 0.7 +/- 0.8).
  
  
  CONCLUSIONS
  Prophylactic DeVega TVA of the donor heart is durable and decreases the incidence of cardiac-related mortality and tricuspid regurgitation after orthotopic heart transplantation. In addition, there is improved protection of renal function. Considering the ease and safety of TVA and its advantages, it should be performed as a routine adjunct to orthotopic heart transplantation.
authors.affiliation: Department of Surgery, University of Chicago, Chicago, Illinois 60637, USA. jeevan@uchicago.edu
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Hyde
authors.initials: H
authors.lastname: Russell
authors.forename: Paul
authors.initials: P
authors.lastname: Mather
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furukawa
authors.forename: Allen
authors.initials: A
authors.lastname: Anderson
authors.forename: Jaishankar
authors.initials: J
authors.lastname: Raman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000517:prevention & control*