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Published on: July 18, 2014
Management options of valvular heart diseases after heart transplantation: A scoping review
Ogulcan Yilmaz1, Niamh M Keenan2
1Department of Anatomy, University of Limerick, School of Medicine, Limerick, Ireland.
Insights
Valvular heart disease is an infrequent complication after heart transplantation, most commonly presenting as tricuspid regurgitation. Management strategies vary, with surgical repair and replacement being more frequent than nonsurgical options.
Area of Science:
- Cardiology
- Transplant Surgery
- Cardiovascular Medicine
Background:
- Acquired valvular heart disease is an infrequent clinical presentation following heart transplantation.
- These conditions can lead to significant valvular changes in transplant recipients.
- Understanding these changes and their management is crucial for patient outcomes.
Purpose of the Study:
- To outline the spectrum of valvular changes observed after heart transplantation.
- To describe the various management options available for these post-transplant valvular conditions.
- To synthesize current knowledge on addressing valvular heart disease in heart transplant recipients.
Main Methods:
- A systematic literature search was conducted using EMBASE, MEDLINE, and PubMed databases.
- Studies included patients undergoing their first heart transplant and those with valvular heart disease.
- Management strategies were categorized into surgical (other than retransplant/valve surgery), valve repair/replacement, nonsurgical interventions, and conservative management.
Main Results:
- Out of 13,757 heart transplant patients, 903 (6.56%) developed valvular disease at a mean of 11.3 years post-transplant.
- Tricuspid regurgitation was the most prevalent valvular issue (94.09%), followed by mitral and aortic regurgitation.
- Surgical valve replacement and repairs (n=89) were more common than nonsurgical interventions (n=20).
Conclusions:
- Acquired valvular heart diseases are an infrequent complication after cardiac transplantation.
- Current data suggests no single superior management approach.
- Further research is necessary to establish optimal treatment strategies for valvular complications post-heart transplant.
Background:
This study aimed to outline the valvular changes following heart transplantation and describe the management options to address these conditions.
Methods:
A literature search using EMBASE, MEDLINE, and PubMed databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. Clinical studies involving patients who had their first heart transplant and articles that mentioned management for valvular heart disease were included. Treatment options were grouped into four categories: cardiac surgery other than retransplant and valve surgery, valve replacement and repairs, nonsurgical interventions, and conservative management.
Results:
Nine hundred and three (6.56%) patients out of 13,757 patients (10,529 males, 3,228 females; mean age: 60.3±10.4 years; range, 20 to 83 years) undergoing heart transplantation were identified with valvular disease affecting one or more valves. The mean interval between the transplant and the diagnosis of valve disease was 11.31±6.95 years. The most common valvular heart disease was tricuspid regurgitation, with 796 (94.09%) occurrences, followed by mitral regurgitation (n=22, 2.6%), aortic regurgitation (n=14, 1.65%), aortic stenosis (n=11, 1.3%), and mitral stenosis (n=3, 0.35%). Additionally, the number of surgical valve replacement and repairs (n=89) was higher than nonsurgical interventions (n=20).
Conclusion:
Acquired valvular heart diseases after cardiac transplantation are an infrequent clinical presentation that can cause valvular changes in the recipient. According to the extracted data, there is no sole superior management option, and more research is needed in this area.
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