Early and Long-Term Outcomes of the Prophylactic Tricuspid Annuloplasty in Heart Transplantation

Purpose Significant tricuspid regurgitation (TR) is considered to adversely affect the clinical outcomes of heart transplantation. Incidence of significant TR has been reported from 20% to 40%. Prophylactic donor heart tricuspid valve annuloplasty (TVA) has been routinely performed during heart transplantation in our institution. The purpose of this study is to summarize and evaluate early and long-term outcomes of prophylactic TVA in heart transplantation. Methods Between August 2011 and August 2021, 350 patients underwent heart transplantation, and 349 patients who underwent concomitant prophylactic TVA were included in this study. TVA was performed using the De Vega annuloplasty technique. TR grade was evaluated with echocardiography, and significant TR was defined as moderate or greater TR in at least two consecutive echocardiographic asssesment. We retrospectively reviewed clinical outcomes including pacemaker implantation, the incidence of significant TR and survival. Long-term survival was assessed between the cohorts who did and did not develop significant TR using the Kaplan-Meier method. Results The mean age was 52.9 ± 13.3 years old and 266 patients (76.2%) were male. Four patients (1.1%) required pacemaker implantation within 1 month after the transplantation: 2 patients for sinus node dysfunction, 1 patient for atrio-ventricular block, and 1 patient for left bundle branch block. Mean follow-up period was 43.8 ± 32.9 months. Ten patients (2.9%, 10/349) developed significant TR during the follow up period. The rate of freedom from significant TR was 98.2% at 1 year, 96.6% at 3 years and 96.6% at 5years. There was no occurrence of tricuspid valve stenosis. The 5-year survival rate of patients who developed significant TR was lower than those who did not (61.7% vs 83.9%, log rank=0.29). Conclusion Prophylactic TVA is safe during the heart transplantation with no TV stenosis and a low rate of patients requiring pacemaker implantation. The incidence of significant TR was exceptionally low compared to published reports. Development of postoperative significant TR might negatively affect the long-term survival compared to those who did not develop significant TR. Significant tricuspid regurgitation (TR) is considered to adversely affect the clinical outcomes of heart transplantation. Incidence of significant TR has been reported from 20% to 40%. Prophylactic donor heart tricuspid valve annuloplasty (TVA) has been routinely performed during heart transplantation in our institution. The purpose of this study is to summarize and evaluate early and long-term outcomes of prophylactic TVA in heart transplantation. Between August 2011 and August 2021, 350 patients underwent heart transplantation, and 349 patients who underwent concomitant prophylactic TVA were included in this study. TVA was performed using the De Vega annuloplasty technique. TR grade was evaluated with echocardiography, and significant TR was defined as moderate or greater TR in at least two consecutive echocardiographic asssesment. We retrospectively reviewed clinical outcomes including pacemaker implantation, the incidence of significant TR and survival. Long-term survival was assessed between the cohorts who did and did not develop significant TR using the Kaplan-Meier method. The mean age was 52.9 ± 13.3 years old and 266 patients (76.2%) were male. Four patients (1.1%) required pacemaker implantation within 1 month after the transplantation: 2 patients for sinus node dysfunction, 1 patient for atrio-ventricular block, and 1 patient for left bundle branch block. Mean follow-up period was 43.8 ± 32.9 months. Ten patients (2.9%, 10/349) developed significant TR during the follow up period. The rate of freedom from significant TR was 98.2% at 1 year, 96.6% at 3 years and 96.6% at 5years. There was no occurrence of tricuspid valve stenosis. The 5-year survival rate of patients who developed significant TR was lower than those who did not (61.7% vs 83.9%, log rank=0.29). Prophylactic TVA is safe during the heart transplantation with no TV stenosis and a low rate of patients requiring pacemaker implantation. The incidence of significant TR was exceptionally low compared to published reports. Development of postoperative significant TR might negatively affect the long-term survival compared to those who did not develop significant TR.