[Cardiac transplantation with bicaval anastomosis and prophylactic graft tricuspid annuloplasty].
OBJECTIVE
This study aims to evaluate the effects of prophylactic heart donor tricuspid annuloplasty in patients after heart transplantation with bicaval anastomosis.


METHODS
From 2002 to 2005, 20 patients undergoing heart transplantation with bicaval anastomosis and with a survival rate over 6 months were deliberately selected. Patients were divided into two groups: Group I - 10 patients who underwent prophylactic heart donor tricuspid annuloplasty by the De Vega technique; and Group II - 10 patients did not undergo annuloplasty. In both groups, presurgical clinical characteristics were the same. The tricuspid regurgitation degree was evaluated by transthoracic Doppler echocardiography and it was qualified from 0 to 3 (0=absent, 1=mild, 2=moderated, 3=severe). Myocardial performance was evaluated by ventricular ejection fraction and invasive hemodynamic study performed during routine endomyocardial biopsies.


RESULTS
Mean clinical follow-up was 14.6+/-4.3 (6 and 16) months. There was only one death in group II. It was not related to annuloplasty. Mean degree of tricuspid regurgitation in Group I was 0.4+/-0.6 and in Group II was 1.6+/-0.8 (p < 0.05). There was a statistically significant difference between both groups in right atrium pressure, which was higher in Group II.


CONCLUSIONS
In view of the limitations of the study, the prophylactic tricuspid annuloplasty in heart donor reduced the degree of valvar regurgitation in the medium term after heart transplantation with bicaval anastomosis, in spite of not interfering with the allograft hemodynamic performance in the period under consideration.
Fiorelli
Alfredo Inácio
AI
Unidade de Perfusão e Assist.Cardiorrespiratória / Transplante InCor, São Paulo, SP-CEP 04015-050. fiorelliai@uol.com.br
Abreu Filho
Carlos Alberto Cordeiro de
CA
Santos
Ronaldo Honorato Barros
RH
Buco
Fernando H A
FH
Fiorelli
Lilian Renata
LR
Bacal
Fernando
F
Bocchi
Edimar Alcides
EA
Stolf
Noedir Antonio Groppo
NA
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D014019:Tissue Donors; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000517:prevention & control / Q000601:surgery*; D055815:Young Adult