The Clinical Impact and Long-Term Outcome of Tricuspid Regurgitation in Patients with Orthotopic Heart Transplantation

PURPOSE: Tricuspid regurgitation (TR) is common in patients with orthotopic heart transplantation (HTX). Nevertheless, the clinical impact and the long-term outcome of TR remains controversial. In this study we aim to elucidate the clinical impact and long-term outcome of TR, taking into account its dynamic nature. METHODS: All consecutive adults patients undergoing biatrial HTX in our tertiary center with a follow-up echocardiogram were included in this study. Mixed-models were used to model the evolution of TR over time. Thereafter, the mixed-model was inserted into a Cox model, under the joint-model framework, in order to address the association of the dynamic TR with mortality. RESULTS: In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 33% of patients had moderate-to-severe TR immediately after surgery. However, this declined to approximately 15% after 5 years and 10% after 10 years of surgery (Fig 1). Predictors of TR were: a higher operation urgency, higher donor age, no pre-implant mechanical assist device, and concurrent post-HTX LV dysfunction. Overall survival at 1, 5, 10, 20 years was 97±1%, 88±1%, 66±2% and 23±2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.08, 95%CI[1.03-1.14], p<0.001). The course of TR was positively correlated with the course of creatinine, ASAT and ALAT. CONCLUSION: Moderate-to-severe TR after HTX is common and the highest immediately after HTX and decreases steadily over the years. TR during follow-up is significantly associated with higher morbidity and mortality. Therefore, further research is urgently needed for the prevention, appropriate medical treatment, and timely surgical intervention of TR post-HTX.

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