%0 Journal Article
%T Tricuspid Valve Regurgitation after Orthotopic Heart Transplantation: Prevalence and Etiology
%A Yaniv Berger
%A Yedael Har Zahav
%A Yigal Kassif
%A Alexander Kogan
%A Rafael Kuperstein
%A Dov Freimark
%A Jacob Lavee
%J Journal of Transplantation
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/120702
%X Background. Tricuspid valve regurgitation (TR) after orthotopic heart transplantation (OHT) is common. The aims of this study were to determine the prevalence of TR after OHT, to examine the correlation between its development and various variables, and to determine its outcomes. Methods. All 163£¿OHT patients who were followed up between 1988 and 2009 for a minimal period of 12 months were divided into those with no TR/mild TR and those with at least mild-moderate TR, as assessed by doppler echocardiography. These groups were compared regarding preoperative hemodynamic variables, surgical technique employed, number of endomyocardial biopsies, number of acute cellular rejections, incidence of graft vasculopathy, and clinical outcomes. Results. At the end of the followup (average 8.2 years) significant TR was evident in 14.1% of the patients. The development of late TR was found by univariate, but not multivariate, analysis to be significantly correlated with the biatrial surgical technique ( ) and the presence of graft vasculopathy ( ). TR development was found to be correlated with the need for tricuspid valve surgery but not with an increased mortality. Conclusions. The development of TR after OHT may be related to the biatrial anastomosis technique and to graft vasculopathy. 1. Introduction Tricuspid regurgitation (TR) after orthotopic heart transplantation (OHT) is common, with reported prevalence that varies from 19% to 84% [1]. The prevalence and severity of TR increase with the length of followup. In most cases TR is mild and asymptomatic, but some cases of moderate or severe TR are related to morbidity and mortality [1¨C5]. Doppler echocardiography is the most common technique used for the detection and evaluation of severity of TR [6, 7]. The treatment of severe symptomatic TR is mainly conservative with diuretics. In refractory cases there is an indication for tricuspid valve repair or replacement surgery. The etiology of TR after OHT is unclear, and several variables have been reported to be related, including the surgical anastomosis technique employed (biatrial versus bicaval) [8¨C13], iatrogenic damage due to endomyocardial biopsies (EMBs) [8, 14¨C18], number of acute cellular rejection episodes (ACRs) [8, 14], pretransplant pulmonary hypertension [8, 19, 20], discordance between the size of the donor¡¯s heart and the recipient¡¯s pericardial cavity [21], and cardiac allograft vasculopathy (CAV) [14]. Preventive measures mentioned in the literature include prophylactic tricuspid annuloplasty during OHT [22¨C24], the use of a long bioptome sheath
%U http://www.hindawi.com/journals/jtrans/2012/120702/