Tricuspid valve replacement after cardiac transplantation.
OBJECTIVE
Tricuspid valve regurgitation is the most frequent valvular complication following orthotopic cardiac transplantation. It leads to diminished quality of life and predicts shortened long-term survival. The optimal surgical management of refractory tricuspid valve regurgitation in this setting is unclear.


RESULTS
Tricuspid valve regurgitation following cardiac transplantation is likely related to accumulated injury from repeated endomyocardial biopsies. Durability of repair in this setting was shown to be suboptimal. Replacement with a bioprosthesis was found to be durable and relieves symptoms of heart failure associated with tricuspid valve regurgitation in the majority of patients. Prophylactic tricuspid valve annuloplasty at transplantation was found to significantly decrease the incidence of early and late tricuspid valve regurgitation; long-term benefits remain unclear.


CONCLUSIONS
Results of tricuspid valve repair in the post-cardiac transplant setting are not ideal, and this strategy is better suited to treating functional tricuspid valve regurgitation resulting from annular dilatation. Tricuspid valve replacement with a bioprosthesis is a safe, durable, and effective method of treating tricuspid valve regurgitation following transplantation and allows for future endomyocardial biopsies to be performed. Mechanical valves should be avoided. A randomized controlled trial examining the long-term outcomes of prophylactic tricuspid annuloplasty is warranted.
Badiwala
Mitesh V
MV
Division of Cardiac Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Rao
Vivek
V
D001706:Biopsy / Q000009:adverse effects; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D014261:Tricuspid Valve / Q000293:injuries / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000517:prevention & control*; D020257:Ventricular Remodeling