Influence of Tricuspid Regurgitation after Heart Transplantation: A 10-Year Single-Center Experience

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 tricuspid valve regurgitation. Our aim was to compare alterations in TVR and its influence on long-term mortality.

Method: We included 160 patients who underwent orthotopic heart transplantation between January 2008 and December 2015 at our center and retrospectively analyzed TVR trends and associated clinical parameters. Mean follow-up time was 8.49 ± 3.78 years (median: 9.27 years, Q1 6.40, Q3 11.50 years). TVR was assessed after 30 days, 1, 3, and 5 years and groups were defined according to changes in TVR grade: constant (group 1, n = 97), improvement (group 2, n = 23), and deterioration (group 3, n = 40). Survival, outcome with regard to operative technique, and long-term kidney and liver function during follow-up were assessed.

Results: Overall mortality was 34.4%, with significant differences between the groups (p = 0.008). Mortality in group 1 was 35.7%, in group was 2 8.7%, and in group 3 was 46.2%. Cox-regression analysis revealed improvement of TVR as a significant predictor for survival (HR: 0.078, 95% CI: 0.011–0.567, p = 0.012). Despite significant differences in survival analysis (long-rank, p = 0.007) deterioration of TVR did not reach statistical significance in regression analysis. (p = 0.069). After 30 days, 5% of the patients showed severe TVR. After 1 year 2.7% of the patients, after 3 years 2.9%, and after 5 years 2.5% of the patients still showed severe TVR. Creatinine level after 3 years showed significant differences between the groups (p = 0.047), deterioration of TVR being associated with higher creatinine levels in long-term follow-up.

Conclusion: Improvement of TVR may function as a positive predictor for long-term survival after orthotopic heart transplantation and therefore needs to be monitored closely in echocardiographic examination. The need for intervention of the tricuspid valve in heart transplant patients requires further investigations, since outcomes of constant TVR and deterioration of TVR do not differ significantly.

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Artikel online veröffentlicht:
03. Februar 2022