Prevalence and Risk Factors of Post-heart Transplant Tricuspid Regurgitation

Tricuspid valve regurgitation (TR) is a common sequela immediately after heart transplantation, and its occurrence has decreased after the adoption of the bicaval anastomosis technique. However, the fate of the tricuspid valve in patients undergoing heart transplantation using the bicaval technique is uncertain.

We identified patients who underwent orthotopic heart transplantation with bicaval technique at our institution between January 2001 and December 2018. Changes in TR on transthoracic echocardiography from the immediately posttransplantation period until 10 y posttransplant were investigated.

A total of 475 consecutive patients (mean age, 49.1 ± 12.7 y; 153 females) who underwent heart transplantation and followed-up for a median of 74.0 mo (interquartile range, 39.5-118.1) were examined. The severities of TR immediately after heart transplantation were less than mild in 194 patients (40.8%), mild in 253 patients (53.3%), moderate in 20 patients (4.2%), and severe in 8 patients (1.7%). The rates of significant TR at 1 mo, 1 y, 3 y, and 5 y were 4.6% (22 of 475), 2.0% (9 of 459), 1.6% (6 of 387), and 1.4% (4 of 289), respectively. Generalized mixed-effects model showed that the TR decreased over time within 1 y (odd ratio, 0.08; 95% confidence interval, 0.02-0.32; P < 0.001) and increased thereafter (odds ratio, 1.37; 95% confidence interval, 1.19-1.58; P < 0.001). There were no patients who required surgical tricuspid valve intervention.

In patients undergoing heart transplantation with the bicaval technique, significant TR was less common than the rates reported in previous studies and showed a trend of improvement within a year after surgery.