A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention

Abstract

(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were as follows: the overall rate of postprocedural TR (immediate, one week, six months, and one year after the procedure), postoperative complications (permanent pacemaker implantation rate, bleeding), redo surgery for TR, and mortality. (3) Results: This meta-analysis included seven studies. Immediate postprocedural, one-week, six-month and one-year tricuspid insufficiency rates were significantly lower in the HTX-A group. There was no difference in permanent pacemaker implantation rate between the groups. The incidence of postoperative bleeding was similar in both arms. The rate of redo surgery for severe TR was reported only by two authors. In both publications, the total number of events was higher in the HTX cohort, meanwhile pooled effect analysis showed no difference among the intervention and control groups. Mortality at one year was similar in both arms. (4) Conclusion: Our study showed that donor heart TA reduces TR incidence in the first year after orthotopic heart transplantation without increasing the surgical complexity. This is a potentially important issue, given the demand for heart transplants and the need to optimize outcomes when this resource is scarce.

Understanding Tricuspid Regurgitation Post Cardiac Transplantation; Why “Anatomical” and “Functional” Just Won’t Cut It

“…One option to reduce long-term TR might be TV annuloplasty at the time of transplant surgery, which has shown some promise. 57 However, fixing a normal valve at the time of transplant may predispose to stenosis or infective endocarditis. To date, there has not been a randomized controlled study of transplant alone versus transplant plus TV ring stratified by severity of TR.…”

Aortic Valve Replacement and Tricuspid Valve Repair Five Years After Orthotopic Heart Transplantation in an Adult Patient

“…Thus, when feasible, conventional operations to correct structural abnormalities in previously transplanted hearts are considered more frequently. Among valve dysfunction after HTx, tricuspid valve diseases are, in absolute terms, the most frequent, reaching an incidence of 84% [ 3 , 4 ]. On the other hand, aortic valve dysfunctions needing redo surgery are more rare conditions.…”

Peri-Operative Care

“…This sentinel dilemma, what is the right procedure, has only grown with the burgeoning number of possible operations supported by modern medical science. In this issue, Bacusca et al perform a meta-analysis on the choice between performing or not performing a prophylactic donor heart tricuspid annuloplasty in an orthotopic heart transplantation [ 9 ]. Their results are suggestive, but a definitive answer, once again, awaits a properly performed randomized clinical trial.…”