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Ann Thorac Surg 2004;78:759-766
© 2004 The Society of Thoracic Surgeons
a Departments of Surgery and Medicine, University of Chicago, Chicago, Illinois, USA
b Departments of Surgery and Medicine, Temple University, Philadelphia, Pennsylvania, USA
Accepted for publication March 30, 2004.
* Address reprint requests to Dr Jeevanandam, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 S Maryland Ave, MC5040, Chicago, IL 60637, USA
jeevan{at}uchicago.edu
Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
Abstract
BACKGROUND: The bicaval technique for orthotopic heart transplantation decreases the incidence of tricuspid valve regurgitation when compared with the standard biatrial technique. This study was designed to study the effects of prophylactic tricuspid valve annuloplasty during bicaval orthotopic heart transplantation on survival, renal function, and amount of tricuspid valve regurgitation.
METHODS: Between April 1997 and March 1998, 60 patients (age 18 to 70 years, 22 women) randomly received either bicaval orthotopic heart transplantation (n = 30) or bicaval orthotopic heart transplantation with DeVega tricuspid valve annuloplasty (n = 30). Tricuspid valve annuloplasty was performed on the donor heart before implantation using pledgeted 2-0 polypropylene suture and sized to an annulus of 29 mm. Echocardiographic variables, laboratory values, and hemodynamics were obtained prospectively and reviewed by an independent data analyst.
RESULTS: Intraoperatively, the group undergoing tricuspid valve annuloplasty had a shorter reperfusion time (46 ± 29 minutes versus 65 ± 48 minutes; p < 0.05) and higher mean pulmonary artery to central venous pressure difference (11.8 ± 3.7 mm Hg versus 15.3 ± 4.1 mm Hg; p = 0.001). Additional differences between the two groups included early mortality from donor dysfunction (4 of 30 patients versus 0 of 30 patients; p < 0.05), amount of tricuspid valve regurgitation at 1 year (1.3 ± 1.0 versus 0.2 ± 0.3; p < 0.05), and percentage of patients with 2+ or greater tricuspid valve regurgitation (34% versus 0%; p < 0.05).
CONCLUSIONS: Tricuspid valve annuloplasty of the donor heart before bicaval orthotopic heart transplantation improves immediate donor heart function as demonstrated by better right ventricular performance, lower perioperative mortality, and shorter reperfusion times. At 1 year, there is less tricuspid valve regurgitation but no difference in renal function. Considering the ease and safety of tricuspid valve annuloplasty and its advantages, it should be performed as a routine adjunct with bicaval orthotopic heart transplantation.
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