Donor Tricuspid Annuloplasty During Orthotopic Heart Transplantation: Long-Term Results of a Prospective Controlled Study

doi:10.1016/j.athoracsur.2006.07.014

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Original Articles: Cardiovascular

Donor Tricuspid Annuloplasty During Orthotopic Heart Transplantation: Long-Term Results of a Prospective Controlled Study

Valluvan Jeevanandam, MD^a^,_*, Hyde Russell, MD^a, Paul Mather, MD^c, Satoshi Furukawa, MD^b, Allen Anderson, MD^a, Jaishankar Raman, MD, PhD^a

^a Departments of Surgery and Medicine, University of Chicago, Chicago, Illinois
^b Department of Surgery, Temple University, Philadelphia, Pennsylvania
^c Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Accepted for publication July 7, 2006.

^_* Address correspondence to Dr Jeevanandam, Section of Cardiac and Thoracic Surgery, University of Chicago, 5841 S Maryland Ave, MC5040, Chicago, IL 60637. (Email: jeevan{at}uchicago.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: Development of tricuspid regurgitation after orthotopic hearttransplantation can cause heart failure along with renal andhepatic impairment and portends a poor prognosis. If tricuspidregurgitation causes significant symptoms, tricuspid valve repairor replacement is often required. This study was designed tostudy the effects of prophylactic tricuspid valve annuloplasty(TVA) during orthotopic heart transplantation on long-term survival,renal function, and amount of tricuspid regurgitation.

METHODS: Between April 1997 and March 1998, 60 patients (aged 18 to 70years; 22 female) randomly received either standard bicavalorthotopic heart transplantation (group STD; n = 30) or bicavalorthotopic heart transplantation with DeVega TVA (group TVA;n = 30). Tricuspid valve annuloplasty was performed on the donorheart before implantation using pledgeted 2-0 polypropyleneand sized to an annulus of 29 mm. Echocardiographic measurements,laboratory values, and hemodynamics were obtained prospectivelyand reviewed by an independent data analyst.

RESULTS: Follow-up of patients as of December 2003 was complete. Althoughthere was a perioperative mortality advantage in group TVA,there was no difference between groups in long-term survival.At the end of the study, however, there was a statistical difference(group STD versus group TVA, p < 0.05) with regard to cardiacmortality (7 of 30 versus 3 of 30), average amount of tricuspidregurgitation (1.5 ± 1.3 versus 0.5 ± 0.4), percentageof patients with 2+ or greater tricuspid regurgitation (34%versus 0%), serum creatinine (2.9 ± 2.0 versus 1.8 ±0.7), and difference in serum creatinine over baseline (2.0± 2.1 versus 0.7 ± 0.8).

CONCLUSIONS: Prophylactic DeVega TVA of the donor heart is durable and decreasesthe incidence of cardiac-related mortality and tricuspid regurgitationafter orthotopic heart transplantation. In addition, there isimproved protection of renal function. Considering the easeand safety of TVA and its advantages, it should be performedas a routine adjunct to orthotopic heart transplantation.

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