Progression of Tricuspid Regurgitation after Heart Transplantation with Concomitant Tricuspid Valve Annuloplasty

Purpose Tricuspid regurgitation (TR) is a significant complication after heart transplantation (HTx). Tricuspid valve annuloplasty (TVA) may be performed empirically at the time of transplant to prevent the development of TR and right ventricular failure. This study aims to investigate the long-term impact of TVA on incidence of TR and survival. Methods All patients transplanted between 1/2010 - 8/2018 were enrolled. At our institution, we routinely perform DeVega TVA during HTx. All echocardiograms post-HTx were evaluated. TR was classified into 5 groups: none, trace, mild, moderate and severe. The incidence of significant TR (moderate or severe) over time and the effect of TR on survival were evaluated. Echocardiograms were evaluated starting 3 months post-HTx. Results 248 patients underwent HTx in this period, and 243 who underwent concomitant TVA were included in this analysis (mean age 54 years, 76% male). During 3.0 ± 2.1 years follow-up, 22 (9.1%) of patients developed significant TR. In the TVA group, survival free of significant TR was 96.9% at 6-months, 94.3% at 1 year, 91.6% at 2 years, 90.8% at 3 years, 90.8% at 4 years, and 88.8% at 5 years (Figure 1A). 5-year survival among those who experienced significant TR was numerically lower, but not significantly different (70.7% vs 81.5%, p=0.24) (Figure 1B). Only 8 (3.3%) patients required permanent pacemaker implantation over a median of 51 days (IQR 14-522) following HTx. Conclusion Significant TR after HTx is common and progressively worsens despite concomitant TVA. The association of significant TR with long-term survival and the benefit of TVA require further evaluation.