Treatment of Tricuspid Regurgitation Following Heart Transplantation: Surgical Approach and Results

Background: Tricuspid valve regurgitation is common after heart transplantation, but the need for replacement or repair is rare. Patients with signs of advanced right-sided heart failure are considered at higher risk for surgery. The aim of this study is to evaluate our experience in the treatment of tricuspid valve regurgitation following heart transplantation. Methods: We reviewed our overall experience in heart transplantation between 1985-2013 (508 cardiac transplants). Five patients (1%) underwent surgical treatment for severe tricuspid regurgitation with right ventricular failure at a median interval of 81 (8-138) months after transplantation. The mechanism of TR was leaflet prolapse, due to chordal rupture after biopsy injury combined with annular dilatation in 3 patients, leaflets thetering combined with annular dilatation in 2. Surgical approach complied in right minithoracotomy and peripheral vessels cannulation for extra corporeal circulation, the procedure was carried out on beating heart. Results: Three patients underwent bioprosthesis valve replacement and 2 ring implantation. Two patients died as consequence of refractory right ventricular failure despite temporary mechanical circulatory support. One patient developed renal failure and cerebral ischemia and another one needed prolonged ventilatory support. During the follow-up (27±13 months) the 3 survivors improved their functional NHYA class (< II in all), neither recurrence of right ventricular failure nor prosthetic or repair failures occurred. Conclusions: The treatment of severe tricuspid regurgitation in cardiac transplant patients is associated with early high morbidity and mortality but with satisfactory mid term results. The presence of severe right ventricular dysfunction seems to have a significant prognostic impact on patients' outcome.