Newswise — Researchers from Erasmus MC in Rotterdam have revealed significant insights into the effects of tricuspid regurgitation (TR) in patients who have undergone biatrial orthotopic heart transplants. Published in Frontiers of Medicine, this study sheds light on the prevalence and implications of TR post-surgery, offering potential guidance for clinical practices.
Tricuspid regurgitation is a condition where the heart’s tricuspid valve does not close tightly, leading to blood flow backward into the right atrium. This study aimed to explore the long-term effects of TR on patients who had received a biatrial orthotopic heart transplant between 1984 and 2017, a group comprising 572 patients with follow-up echocardiograms.
Biatrial orthotopic heart transplantation has been a standard procedure for patients with severe heart failure. However, post-operative complications such as tricuspid regurgitation are common and can impact patient outcomes. Existing literature suggests that TR can lead to increased mortality and associated complications, yet its dynamic progression and long-term clinical implications remain unclear.
The study found that approximately 32% of patients experienced moderate-to-severe TR immediately following surgery. This figure declined to 11% at 5 years and 9% at 10 years post-surgery, indicating a potential natural decline in TR severity over time. The researchers discovered that pre-implant mechanical support was associated with lower TR severity during follow-up, while concurrent left ventricular dysfunction correlated with increased TR incidence during follow-up.
Importantly, moderate-to-severe TR during follow-up was associated with a higher mortality rate, with a hazard ratio of 1.07. Furthermore, the study highlighted a significant positive correlation between longitudinal changes in TR severity and creatinine levels, as measured by creatinine levels.
The researchers utilized a mixed-model approach to analyze the evolution of TR, integrating these findings into a Cox model to assess the association with mortality. This robust statistical framework enabled adjustment for survival-related confounding and provide reliable insights into TR’s clinical impact.
These findings emphasize the importance of monitoring TR in heart transplant patients, particularly given its association with increased mortality and renal dysfunction. The study suggests that surgical intervention for TR might be unnecessary in the early post-transplant period, as TR severity decreases over time when adjusted for survival bias. This could inform clinical guidelines and patient management strategies, potentially improving long-term outcomes for heart transplant recipients.
The study was supported by the National Institutes of Health and conducted in collaboration with the Departments of Cardiothoracic Surgery, Cardiology, and Biostatistics at Erasmus MC. For more detailed findings, the full research article is available in Frontiers of Medicine: https://journal.hep.com.cn/fmd/EN/10.1007/s11684-022-0967-5. Future research will continue to explore the mechanisms driving TR progression and its broader implications on heart transplant success.