The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant
Kevin M. Veen1, Grigorios Papageorgiou2, Casper F. Zijderhand1, Mostafa M. Mokhles1, Jasper J. Brugts3, Olivier C. Manintveld3, Alina A. Constantinescu3, Jos A. Bekkers1, Johanna J.M. Takkenberg1, Ad J.J.C. Bogers1, Kadir Caliskan3()
1. Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA Rotterdam, The Netherlands 2. Department of Biostatistics, Erasmus MC, 3000 CA Rotterdam, The Netherlands 3. Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984−2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02–1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.
. [J]. Frontiers of Medicine, 2023, 17(3): 527-533.
Kevin M. Veen, Grigorios Papageorgiou, Casper F. Zijderhand, Mostafa M. Mokhles, Jasper J. Brugts, Olivier C. Manintveld, Alina A. Constantinescu, Jos A. Bekkers, Johanna J.M. Takkenberg, Ad J.J.C. Bogers, Kadir Caliskan. The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant. Front. Med., 2023, 17(3): 527-533.
RC Wong, Z Abrahams, M Hanna, J Pangrace, G Gonzalez-Stawinski, R Starling, D Taylor. Tricuspid regurgitation after cardiac transplantation: an old problem revisited. J Heart Lung Transplant 2008; 27(3): 247–252 https://doi.org/10.1016/j.healun.2007.12.011
pmid: 18342744
2
R De Simone, R Lange, RU Sack, H Mehmanesh, S Hagl. Atrioventricular valve insufficiency and atrial geometry after orthotopic heart transplantation. Ann Thorac Surg 1995; 60(6): 1686–1693 https://doi.org/10.1016/0003-4975(95)00716-4
pmid: 8787464
3
TM Aziz, MI Burgess, AN Rahman, CS Campbell, AK Deiraniya, NA Yonan. Risk factors for tricuspid valve regurgitation after orthotopic heart transplantation. Ann Thorac Surg 1999; 68(4): 1247–1251 https://doi.org/10.1016/S0003-4975(99)00768-7
pmid: 10543487
4
K CaliskanM StrachinaruOI Soliman. Tricuspid Regurgitation in Patients with Heart Transplant. In: Soliman OI, ten Cate FJ, Practical Manual of Tricuspid Valve Diseases. Cham: Springer International Publishing; 2018: 49–58
5
M Wartig, S Tesan, J Gäbel, A Jeppsson, N Selimovic, E Holmberg, G Dellgren. Tricuspid regurgitation influences outcome after heart transplantation. J Heart Lung Transplant 2014; 33(8): 829–835 https://doi.org/10.1016/j.healun.2014.04.005
pmid: 24845342
6
JP Sun, J Niu, MK Banbury, L Zhou, DO Taylor, RC Starling, MJ Garcia, WJ Stewart, JD Thomas. Influence of different implantation techniques on long-term survival after orthotopic heart transplantation: an echocardiographic study. J Heart Lung Transplant 2007; 26(12): 1243–1248 https://doi.org/10.1016/j.healun.2007.09.016
pmid: 18096474
7
RR Lower, NE Shumway. Studies on orthotopic homotransplantation of the canine heart. Surg Forum 1960; 11: 18–19
pmid: 13763847
8
AA Tsiatis, M Davidian. Joint modeling of longitudinal and time-to-event data: an overview. Stat Sin 2004; 14(3): 809–834
9
MK Lewen, RJ Bryg, LW Miller, GA Williams, AJ Labovitz. Tricuspid regurgitation by Doppler echocardiography after orthotopic cardiac transplantation. Am J Cardiol 1987; 59(15): 1371–1374 https://doi.org/10.1016/0002-9149(87)90922-2
pmid: 3296726
10
SJ Bhatia, JM Kirshenbaum, RJ Shemin, LH Cohn, JJ Collins, Sesa VJ Di, PJ Young, GH Jr Mudge, MG Sutton. Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation. Circulation 1987; 76(4): 819–826 https://doi.org/10.1161/01.CIR.76.4.819
pmid: 3308165
11
B Hausen, JM Albes, R Rohde, S Demertzis, A Mügge, HJ Schäfers. Tricuspid valve regurgitation attributable to endomyocardial biopsies and rejection in heart transplantation. Ann Thorac Surg 1995; 59(5): 1134–1140 https://doi.org/10.1016/0003-4975(95)00089-4
pmid: 7733709
12
CF Zijderhand, KM Veen, K Caliskan, T Schoonen, MM Mokhles, JA Bekkers, OC Manintveld, AA Constantinescu, JJ Brugts, AJJC Bogers, JJM Takkenberg. Biatrial vs. bicaval orthotopic heart transplantation: a systematic review and meta-analysis. Ann Thorac Surg 2020; 110(2): 684–691 https://doi.org/10.1016/j.athoracsur.2019.12.048
pmid: 32035050
13
P Atluri, AS Fairman, JW MacArthur, AB Goldstone, JE Cohen, JL Howard, CM Zalewski, Y Shudo, YJ Woo. Continuous flow left ventricular assist device implant significantly improves pulmonary hypertension, right ventricular contractility, and tricuspid valve competence. J Card Surg 2013; 28(6): 770–775 https://doi.org/10.1111/jocs.12214
pmid: 24118109
14
Y Berger, Y Har Zahav, Y Kassif, A Kogan, R Kuperstein, D Freimark, J Lavee. Tricuspid valve regurgitation after orthotopic heart transplantation: prevalence and etiology. J Transplant 2012; 2012: 120702 https://doi.org/10.1155/2012/120702
pmid: 23097690
15
LE Zijlstra, AA Constantinescu, O Manintveld, O Birim, DA Hesselink, R van Thiel, R van Domburg, AH Balk, K Caliskan. Improved long-term survival in Dutch heart transplant patients despite increasing donor age: the Rotterdam experience. Transpl Int 2015; 28(8): 962–971 https://doi.org/10.1111/tri.12503
pmid: 25486862
16
CA Anderson, SK Shernan, M Leacche, JD Rawn, S Paul, T Mihaljevic, JA Jarcho, LW Stevenson, JC Fang, EF Lewis, GS Couper, GH Mudge, JG Byrne. Severity of intraoperative tricuspid regurgitation predicts poor late survival following cardiac transplantation. Ann Thorac Surg 2004; 78(5): 1635–1642 https://doi.org/10.1016/j.athoracsur.2004.05.028
pmid: 15511447
17
TM Aziz, RA Saad, MI Burgess, CS Campbell, NA Yonan. Clinical significance of tricuspid valve dysfunction after orthotopic heart transplantation. J Heart Lung Transplant 2002; 21(10): 1101–1108 https://doi.org/10.1016/S1053-2498(02)00433-3
pmid: 12398875
18
V JeevanandamH RussellP MatherS FurukawaA AndersonJ Raman. Donor tricuspid annuloplasty during orthotopic heart transplantation: long-term results of a prospective controlled study. Ann Thorac Surg 2006; 82(6): 2089–2095 doi:10.1016/j.athoracsur.2006.07.014
pmid: 17126116
E Agricola, C Marini, S Stella, A Monello, A Fisicaro, V Tufaro, M Slavich, M Oppizzi, A Castiglioni, A Cappelletti, A Margonato. Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure. J Cardiovasc Med (Hagerstown) 2017; 18(2): 60–68 https://doi.org/10.2459/JCM.0000000000000312
pmid: 26258726
21
N Karam, D Braun, M Mehr, M Orban, TJ Stocker, S Deseive, M Orban, C Hagl, M Näbauer, S Massberg, J Hausleiter. Impact of transcatheter tricuspid valve repair for severe tricuspid regurgitation on kidney and liver function. JACC Cardiovasc Interv 2019; 12(15): 1413–1420 https://doi.org/10.1016/j.jcin.2019.04.018
pmid: 31126888
22
R Alharethi, F Bader, AG Kfoury, ME Hammond, SV Karwande, EM Gilbert, DB Doty, ME Hagan, H Thomas, DG Renlund. Tricuspid valve replacement after cardiac transplantation. J Heart Lung Transplant 2006; 25(1): 48–52 https://doi.org/10.1016/j.healun.2005.07.009
pmid: 16399530
23
F Filsoufi, SP Salzberg, CA Anderson, GS Couper, LH Cohn, DH Adams. Optimal surgical management of severe tricuspid regurgitation in cardiac transplant patients. J Heart Lung Transplant 2006; 25(3): 289–293 https://doi.org/10.1016/j.healun.2005.09.013
pmid: 16507421
24
NA Solomon, J McGiven, XZ Chen, PM Alison, KJ Graham, H Gibbs. Biatrial or bicaval technique for orthotopic heart transplantation: which is better?. Heart Lung Circ 2004; 13(4): 389–394 https://doi.org/10.1016/j.hlc.2004.06.014
pmid: 16352223