Impact of Prophylactic Donor Heart Tricuspid Valve Annuloplasty in Long-Term Clinical Outcomes of Heart Transplantation

• Published in: The Journal of heart and lung transplantation Vol. 39; no. 4; p. S44
• Main Authors: Nishida, H., Jeevanandam, V., Koda, Y., Song, T., Onsager, D., Nguyen, A., Grinstein, J., Chung, B., Smith, B., Kalantari, S., Sarswat, N., Kim, G., Ota, T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2020
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2020.01.1213

Significant tricuspid regurgitation (TR) is reported in over 30% of patients following heart transplantation and can adversely affect outcomes. To decrease the incidence of TR, prophylactic donor heart tricuspid valve annuloplasty (TVA) has been routinely performed in heart transplantation in our institution. The purpose of this study is to assess long-term clinical outcomes of prophylactic TVA in heart transplantation.
Between January 2010 and August 2019, 308 patients underwent heart transplantation, and 297 patients who underwent concomitant prophylactic TVA were included in this study. TVA was performed using the De Vega annuloplasty technique. TR grade was evaluated with echocardiography. We reviewed long-term clinical outcomes including pacemaker implantation for conduction disease, the incidence of significant TR (defined as ≥ moderate TR) and survival. Long-term survival was compared in patients who did and did not develop significant TR using the Kaplan-Meier method. We also investigated if significant TR was associated with long-term survival by Cox proportional hazards analysis.
The mean age was 53.6 ± 13.0 years old and 232 patients (77.9%) were male. Mean follow-up period was 37.9 ± 29.3 months. Five patients required pacemaker implantation in 1 month after the transplantation: 4 patients for sick node dysfunction and 1 patient for atrio-ventricular block. Twenty four patients (8.1%, 24/297) newly developed significant TR during the follow up period. The rate of freedom from significant TR was 90.4% at 1 year, 87.9% at 3 years and 84.6% at 5years. The survival rate of all patients was 92.7% at 1 year, 85.3% at 3 years and 80.0% at 5 years. The survival rate of patients who developed significant TR was significantly lower than those who did not develop significant TR (5-year survival 50.0% with TR, 83.3% without TR; log rank=0.025). Cox proportional hazards analysis revealed that postoperative significant TR was associated with long-term mortality (hazard ratio 4.42, 95% CI 1.16 - 15.6, p=0.03).
Compared to published reports, prophylactic donor heart TVA reduces the incidence of TR. Development of postoperative significant TR negatively impacted the long-term survival compared to those who did not develop significant TR and was an independent predictor of long-term mortality.