Prophylactic donor tricuspid annuloplasty in orthotopic bicaval heart transplantation.
OBJECTIVE
The objective of this study was to evaluate the effects of prophylactic heart donor tricuspid annuloplasty to improve the degree of valvar regurgitation and the hemodynamic performance after orthotopic heart transplantation using bicaval anastomosis.


METHODS
From March 1985 to December 2005, of the 368 patients undergoing orthotopic heart transplantation, 20 patients were selected because they survived more than 6 months. They were divided into 2 groups: group I-10 patients underwent prophylactic heart donor tricuspid annuloplasty by the De Vega technique; group II-10 patients did not receive a graft with this procedure. Their presurgical clinical characteristics were the same. In the postsurgical period, tricuspid regurgitation degree evaluated by transthoracic Doppler echocardiography was qualified from 0 to 3: 0 = absent; 1 = mild; 2 = moderate; and 3 = severe. Myocardial performance was evaluated by the ventricular ejection fraction and by an invasive hemodynamic study, performed during routine endomyocardial biopsies.


RESULTS
At a follow-up of 14.6 +/- 4.3 months (6 and 16 months), group I showed no mortality, whereas group II had 10% (P > .05). However, it was not related to the annuloplasty. The mean degree of tricuspid regurgitation in group I was 0.4 +/- 0.6; in group II, 1.6 +/- 0.8 (P < .05). There was a significant difference between the 2 groups in the right atrium pressure, which was higher in group II.


CONCLUSIONS
Prophylactic tricuspid annuloplasty in the heart donor significantly reduced the degree of valvular regurgitation after heart transplantation using a bicaval anastomosis without significantly interfering with the hemodynamic performance of the allograft.
Fiorelli
A I
AI
Heart Institute of Medicine School of São Paulo University, Rua Morgado de Mateus 126/81, CEP 04015-050, São Paulo/SP, Brazil. fiorelliai@uol.com.br
Stolf
N A G
NA
Abreu Filho
C A C
CA
Santos
R H B
RH
Buco
F H A
FH
Fiorelli
L R
LR
Issa
V
V
Bacal
F
F
Bocchi
E A
EA
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002196:Capillaries / Q000502:physiology; D009202:Cardiomyopathies / Q000145:classification / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*