title: Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes.
abstract: OBJECTIVE
  Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed.
  
  
  METHODS
  A retrospective cohort.
  
  
  METHODS
  A tertiary-care hospital.
  
  
  METHODS
  Patients who underwent OLT between January 1, 2003 and February 4, 2012.
  
  
  METHODS
  After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant.
  
  
  RESULTS
  From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46).
  
  
  CONCLUSIONS
  This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: Sharon.McCartney@duke.edu.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: McCartney
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Mary
authors.initials: M
authors.lastname: Cooter
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sivak
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Anthony
authors.initials: A
authors.lastname: Castleberry
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gregory
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: John
authors.initials: J
authors.lastname: Haney
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hartwig
authors.affiliation: Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000639:trends; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: lung transplantation; mitral incompetence; mitral insufficiency; mitral regurgitation; mitral valve incompetence; mitral valve insufficiency; mitral valve regurgitation