Risk factors for tricuspid valve regurgitation after orthotopic heart transplantation

Background. Tricuspid regurgitation (TR) may occur following orthotopic hea rt transplantation (OHT) and although a number of etiological factors have been suggested, the relative contribution of each of these remains to be el ucidated. We aimed to assess the risk factors for TR in our 10-year experie nce of orthotopic heart transplantation (OHT). Methods. OHT was performed in 249 patients (161 by the standard technique a nd 88 by the bicaval technique). TR was assessed using transthoracic color Doppler echocardiography. Results. Recipients who underwent operation by the standard technique displ ayed higher incidence of moderate and severe TR than did bicaval-technique recipients. The development of early TR was also correlated to rejection gr eater than or equal to grade 2, preoperative raised transpulmonary gradient , and raised pulmonary vascular resistance. Risk factors for late TR were s tandard technique (p < 0.0001), number of rejection greater than or equal t o grade 2 (p < 0.004), and the total number of heart biopsies (p < 0.02). R ecipients with moderate and severe TR revealed elevated right-side pressure s and advanced New York Heart Association statues compared to those with no , trivial, or mild TR. Conclusions. Various factors contribute to TR after OHT, the prevalence of which might be lowered by adopting the bicaval technique, early treatment o f rejection, and reduction of the number of biopsies performed. (C) 1999 by The Society of Thoracic Surgeons.