TY - JOUR
T1 - The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant
AU - Veen, Kevin M
AU - Papageorgiou, Grigorios
AU - Zijderhand, Casper F
AU - Mokhles, Mostafa M
AU - Brugts, Jasper J
AU - Manintveld, Olivier C
AU - Constantinescu, Alina A
AU - Bekkers, Jos A
AU - Takkenberg, Johanna J M
AU - Bogers, Ad J J C
AU - Caliskan, Kadir
N1 - Publisher Copyright:
© 2023, Higher Education Press.
PY - 2023/6
Y1 - 2023/6
N2 - In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.
AB - In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.
KW - Adult
KW - Echocardiography
KW - Heart Transplantation
KW - Humans
KW - Male
KW - Middle Aged
KW - Retrospective Studies
KW - Treatment Outcome
KW - Tricuspid Valve Insufficiency/diagnostic imaging
KW - Ventricular Dysfunction, Left
U2 - 10.1007/s11684-022-0967-5
DO - 10.1007/s11684-022-0967-5
M3 - Article
C2 - 37000348
SN - 2095-0217
VL - 17
SP - 527
EP - 533
JO - Frontiers of medicine
JF - Frontiers of medicine
IS - 3
ER -