Outcomes of surgical tricuspid valve intervention after heart transplant

Tricuspid regurgitation (TR) is common following heart transplant (HTx). Data on the outcomes of tricuspid valve (TV) surgery after HTx is limited. This study evaluates the short- and long-term outcomes of TV surgery after HTx and identifies predictors of mortality.

A retrospective analysis of all HTx recipients undergoing TV surgery between 2000-2019 within the Mayo Clinic Health System was performed. Demographic, echocardiographic, hemodynamic, and postoperative outcomes were collected. Survival was estimated using Kaplan-Meier analysis, and univariable Cox regression analysis was used to identify mortality-associated risk factors.

Forty-one patients (mean age 53.9±14.4 years) underwent TV surgery after HTx. Biopsy-related leaflet injury (22 patients) and annular dilation (16 patients) were the most common mechanisms of TR. Nine patients underwent TV surgery during the index hospitalization of HTx, while 32 patients were operated on during follow-up. After TV surgery, 5- and 10- year survival was 60.5% and 23.5%, respectively. There were 23 deaths (5 during the index hospitalization for TV surgery, while 18 died during follow-up). Preoperative predictors of mortality were elevated right atrial pressure (RAP), right ventricular end-diastolic pressure (RVEDP), and mean pulmonary artery pressure (mPAP), and international normalized ratio (INR), along with hypoalbuminemia (P<0.05). Postoperative predictors were right ventricular (RV) dysfunction, elevated RAP, RVEDP, mPAP, reduced pulmonary artery pulsatility index (PAPi), hyperbilirubinemia, and an elevated INR (all P<0.05).

TV surgery after HTx is associated with significant early and late mortality. In HTx recipients, TV surgery should be performed before the onset of RV dysfunction and hepatic dysfunction.