Tricuspid regurgitation influences outcome after heart transplantation

Abstract

Background: We investigated the correlation between tricuspid regurgitation (TR) and late survival, and its relation to bicaval (BC) and biatrial (BA) technique, after heart transplantation (HTx).

Methods: HTx was performed in 464 patients between 1984 and 2009 at Sahlgrenska University Hospital. The BA technique was mostly performed in the early experience and BC in the late experience. Most patients underwent echocardiograms, and data for TR were retrospectively gathered at discharge and at the 5-year and 10-year follow-up. Survival with regard to surgical technique and to post-operative TR was analyzed.

Results: The BC technique resulted in less early TR (p < 0.001). This difference was still observed among survivors at 5 years (p = 0.013) but not at 10 years (p = 0.082). A multivariate logistic regression analysis found the BA technique was the only predictor of early moderate to severe TR (odds ratio, 2.70; 95% confidence interval, 1.68-4.32; p < 0.001). Furthermore, when time era was introduced, it became the only significant predictor, with a lower risk to develop moderate to severe early post-operative TR in more recent eras. There was no significant difference in long-term survival between the 2 surgical technique groups. However, stratified for TR at discharge, patients with mild or no TR had better survival than those with moderate or severe TR (p < 0.01).

Conclusions: The BC technique results in less TR early post-operatively. The BA technique and/or time era seem to predict the occurrence of early moderate to severe TR. Regardless of the technique used, patients with moderate or severe TR at discharge have an increased mortality during the first 5 years.

Keywords: follow-up studies; heart transplantation; surgical technique; tricuspid regurgitation.