Open Access

Rebecca Krey, Wiebke Sommer, Anna Meyer, Rasmus Rivinius, Philipp Schlegel, Norbert Frey, Matthias Karck, Gregor Warnecke, Rawa Arif

• Background. Tricuspid valve regurgitation (TVR) is often observed after orthotopic heart transplantation. However, there is a scarcity of data regarding long-term outcomes of patients with TVR. Methods. Between January 2008 and December 2015, 169 patients underwent orthotopic heart transplantation at our center and were included in this study. TVR trends and associated clinical parameters were retrospectively analyzed. TVR was assessed after 30 d, 1 y, 3 y, and 5 y, and groups were defined according to changes in TVR grade: constant (group 1; n = 100), improvement (group 2; n = 26), and deterioration (group 3; n = 43). Survival, outcome with regard to operative technique, and long-term kidney and liver function during follow-up were assessed. Results. Mean follow-up time was 7.67 ± 4.17 y (median 8.62, Q1 5.06, Q3 11.16). Overall mortality was 42.0%, with differences between the groups (P < 0.01). Cox regression analysis revealed improvement of TVR as a significant predictor forBackground. Tricuspid valve regurgitation (TVR) is often observed after orthotopic heart transplantation. However, there is a scarcity of data regarding long-term outcomes of patients with TVR. Methods. Between January 2008 and December 2015, 169 patients underwent orthotopic heart transplantation at our center and were included in this study. TVR trends and associated clinical parameters were retrospectively analyzed. TVR was assessed after 30 d, 1 y, 3 y, and 5 y, and groups were defined according to changes in TVR grade: constant (group 1; n = 100), improvement (group 2; n = 26), and deterioration (group 3; n = 43). Survival, outcome with regard to operative technique, and long-term kidney and liver function during follow-up were assessed. Results. Mean follow-up time was 7.67 ± 4.17 y (median 8.62, Q1 5.06, Q3 11.16). Overall mortality was 42.0%, with differences between the groups (P < 0.01). Cox regression analysis revealed improvement of TVR as a significant predictor for survival (hazard ratio 0.23; 95% confidence interval, 0.08-0.63, P < 0.01). After 1 y 2.7%, after 3 y 3.7%, and after 5 y 3.9% of the patients showed persistent severe TVR. Creatinine levels after 30 d and 1, 3, and 5 y showed significant differences between the groups (P = 0.02, P < 0.01, P < 0.01, and P = 0.01), deterioration of TVR being associated with higher creatinine levels during follow-up. Conclusions. Deterioration of TVR is associated with higher mortality and renal dysfunction. Improvement of TVR may function as a positive predictor for long-term survival after heart transplantation. Improvement of TVR should be a therapeutic goal offering a prognostic value for long-term survival. Outcomes after orthotopic heart transplantation, the gold-standard therapy for end-stage heart failure, have significantly improved since the first transplantation in 1967.1,2 Median survival of patients who received heart transplantation during the last 2 decades has reached 12.5 y. Besides allograft vasculopathy and infectious complications, tricuspid valve regurgitation (TVR) in the allograft has been associated with decreased long-term survival.3,4 TVR is the most common valvular complication in patients after cardiac transplantation, with a reported incidence of up to 84%.5 Approximately 34% of these patients experience a decreased quality of life because of symptoms like fatigue, dyspnea, arrhythmias, peripheral edemas, or cirrhosis cardiaque as a result of moderate or severe regurgitation.3,6 The cause of TVR after heart transplantation remains to be the subject of discussion: number of biopsies, disturbances in the geometry of the tricuspid valve or the right ventricle because of anastomotic technique, preoperative recipient pulmonary vascular resistance, ischemic time of the donor heart, sex of donor and recipient, donor–recipient size mismatch, or the presence of TVR in the donor heart have all been argued to influence TVR after cardiac transplantation.7,8 There is no consensus on whether prophylactic simultaneous or 2-staged management of the tricuspid valve during heart transplantation is beneficial.3,9 Surgical management options include Carpentier’s ring annuloplasty, De Vega technique, and valve replacement.10-12 Other publications postulate that, in most cases, significant TVR improves within the first postoperative year after transplantation without intervention.2 The aim of this study was to compare alterations in TVR, with and without surgical correction, and its influence on long-term mortality and morbidity after 1, 3, and 5 y of close monitoring.…