Tricuspid valve replacement after cardiac transplantation

Background: Tricuspid regurgitation (TR) occurs commonly in transplanted hearts. Although theoretically attractive, tricuspid valve replacement (TVR) has not been widely investigated as a possible therapy in post-transplant patients. The purpose of this study was to determine the safety of TVR in heart transplant patients and its effects on measurable clinical endpoints. Methods: We acquired data by both retrospective chart review and prospective data collection in all patients who underwent TVR after cardiac transplantation. Results: Nine patients were identified and followed for a period of six months. The age of patients at time of TVR was 62 +/- 6.1 yr and their average time since transplantation was 12 +/- 3.2 yr. Most patients demonstrated a reduction in their furosemide dose (105 +/- 63 mg/d pre-TVR vs. 67.5 +/- 65 mg/d post-TVR, p = 0.001) with a reduction in serum creatinine levels (188 +/- 72 mu mol/L pre-TVR vs. 143 +/- 42 mu mol/L post-TVR, p = 0.06). Additionally, we found a significant improvement in albumin values (32 +/- 5 g/L pre-TVR vs. 42 +/- 3 g/L post-TVR, p = 0.002) as well as an improvement in total bilirubin (35 +/- 18 mu mol/L pre-TVR vs. 18 +/- 5 mu mol/L post-TVR, p = 0.05). There was only one death in our series, in the only patient with known severe graft atherosclerosis. Conclusions: TVR appears to be a safe procedure in patients without severe graft atherosclerosis with improvements in serum creatinine, albumin and total bilirubin values, in addition to a reduction in furosemide dose. This may reflect improved forward flow, improved symptomatology from TR as well as possible beneficial effects on nutritional status.