Tricuspid valve replacement after cardiac transplantation

Abstract

Background: Tricuspid regurgitation (TR) occurs commonly in transplanted hearts. Although theoretically attractive, tricuspid valve replacement (TVR) has not been widely investigated as a possible therapy in post-transplant patients. The purpose of this study was to determine the safety of TVR in heart transplant patients and its effects on measurable clinical endpoints. Methods: We acquired data by both retrospective chart review and prospective data collection in all patients who underwent TVR after cardiac transplantation. Results: Nine patients were identified and followed for a period of six months. The age of patients at time of TVR was 62 ± 6.1 yr and their average time since transplantation was 12 ± 3.2 yr. Most patients demonstrated a reduction in their furosemide dose (105 ± 63 mg/d pre-TVR vs. 67.5 ± 65 mg/d post-TVR, p = 0.001) with a reduction in serum creatinine levels (188 ± 72 μmol/L pre-TVR vs. 143 ± 42 μmol/L post-TVR, p = 0.06). Additionally, we found a significant improvement in albumin values (32 ± 5 g/L pre-TVR vs. 42 ± 3 g/L post-TVR, p = 0.002) as well as an improvement in total bilirubin (35 ± 18 μmol/L pre-TVR vs. 18 ± 5 μmol/L post-TVR, p = 0.05). There was only one death in our series, in the only patient with known severe graft atherosclerosis. Conclusions: TVR appears to be a safe procedure in patients without severe graft atherosclerosis with improvements in serum creatinine, albumin and total bilirubin values, in addition to a reduction in furosemide dose. This may reflect improved forward flow, improved symptomatology from TR as well as possible beneficial effects on nutritional status. © 2006 Blackwell Munksgaard.