In-Hospital Outcomes and Trends of Tricuspid Valve Surgery in Heart Transplant Patients

Abstract

Introduction: Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods: We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results: A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions: TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.

Percutaneous Tricuspid Valve Repair

“…Severe TR inevitably leads to RV dilatation combined with a potential overestimation of RV function. However, RV function is an important determinant of the most common postoperative complications in OHT patients (cardiogenic shock and acute kidney injury) ( 2 ). Both our patients had dilated RVs with seemingly normal function.…”

“…Severe TR is associated with increased morbidity and mortality. However, tricuspid valve (TV) surgery in OHT patients is also associated with high perioperative risk, and therefore, alternative treatment options are warranted ( 2 ). We present 2 cases of elderly OHT patients with severe TR who underwent percutaneous treatment.…”

Edge‐to‐edge tricuspid valve repair for severe tricuspid regurgitation 20 years after cardiac transplantation

“…3 Although successful surgical repair or replacement can lead to significant improvement in heart failure, tricuspid surgery after heart transplant is associated with high morbidity and mortality. 12 The experience in percutaneous tricuspid valve repair has been accumulating. A recent multicenter observational study reported 97% procedural success rate of percutaneous tricuspid valve repair using MitraClip system as well as improvement in heart failure symptoms in non-surgical candidates with severe tricuspid regurgitation.…”

“…Surgical corrections by either repair or replacement have been the mainstay of the treatment for diuretic‐refractory cases 3 . Although successful surgical repair or replacement can lead to significant improvement in heart failure, tricuspid surgery after heart transplant is associated with high morbidity and mortality 12 …”

First Bicaval Valve Implantation in a Heart Transplant Patient to Treat Severe Symptomatic Tricuspid Regurgitation

“…1 However, tricuspid surgery in HT patients is associated with a number of complications. 2 Thus, severe TR, which is often associated with right heart failure symptoms and increased mortality, remains a major unsolved problem in many HT patients.…”