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Lechiancole A, Sponga S, Bortolotti U, De Pellegrin A, Livi U, Vendramin I. Artificial Neochordae for Tricuspid Valve Repair in Adults: A Review. Thorac Cardiovasc Surg 2024. [PMID: 38991531 DOI: 10.1055/s-0044-1788036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Expanded polytetrafluoroethylene (ePTFE) neochordae are predominantly used for mitral valve repair (MVr), while the frequency of their employment in tricuspid valve surgery is not well assessed. We have performed a review of the available literature to verify incidence, indications, techniques, and outcomes of the use of artificial neochordae in a variety of tricuspid valve pathologies. We found a total of 57 articles reporting the use of ePTFE sutures in patients in whom tricuspid valve repair (TVr) was performed. From such articles, adequate information on the basic disease, surgical techniques, and outcomes could be obtained in 45 patients in whom the indication to the use of neochordae was posttraumatic tricuspid regurgitation (n = 24), infective endocarditis (n = 8), congenital valvular disease (n = 6), valve injury during cardiac neoplasm excision (n = 3) or following repeated endomyocardial biopsies after heart transplantation (n = 3), and tricuspid valve prolapse (n = 1). Implant techniques generally replicated those currently employed for MVr using artificial neochordae. There were no reported hospital deaths with stability of repair in most cases at follow-up controls. TVr using ePTFE neochordae has been reported so far in a limited number of patients. Nevertheless, it appears a feasible and reproducible technique to be added routinely to the surgical armamentarium during TVr.
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Affiliation(s)
- Andrea Lechiancole
- Cardiothoracic Department, Cardiac Surgery Unit, University Hospital, Udine, Italy
| | - Sandro Sponga
- Cardiothoracic Department, Cardiac Surgery Unit, University Hospital, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, Cardiac Surgery Unit, University Hospital, Udine, Italy
| | | | - Ugolino Livi
- Cardiothoracic Department, Cardiac Surgery Unit, University Hospital, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, Cardiac Surgery Unit, University Hospital, Udine, Italy
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Cuko B, Baudo M, Beurton A, Busuttil O, Pernot M. Aortic Valve Replacement and Tricuspid Valve Repair Five Years After Orthotopic Heart Transplantation in an Adult Patient. Cureus 2023; 15:e44688. [PMID: 37809256 PMCID: PMC10551574 DOI: 10.7759/cureus.44688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In the current era of improved survival after orthotopic heart transplantation, post-transplant valve dysfunction is not an uncommon occurrence. The first treatment is medical management, but when it fails, surgery, possibly as retransplantation, may be needed. However, due to the scarcity of donor hearts, efforts are being made on the preservation of the cardiac allograft function by conventional operations in lieu of retransplantation. In this case report, we present a patient developing severe aortic valve insufficiency and moderate-to-severe functional tricuspid valve insufficiency five years after cardiac transplant, leading to progressive clinical deterioration and heart failure symptoms. The aortic valve was replaced with an Edwards Inspiris Resilia Nr. 23 biological prosthesis, and the tricuspid valve was repaired with a Medtronic Contour 3D Nr. 28 annuloplasty. The postoperative course was uneventful, and the patient remained well six months after her reintervention. In the literature, cases of patients undergoing valve operations following their heart transplants have already been described. However, to the best of our knowledge, this is the first case report describing a concomitant procedure of aortic valve replacement and tricuspid valve repair in an adult patient occurring five years after her cardiac transplant.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, ITA
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, BEL
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, FRA
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Pessac, FRA
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Bart NK, Hungerford SL, Namasivayam M, Granger E, Conellan M, Kotlyar E, Muthiah K, Jabbour A, Hayward C, Jansz PC, Keogh AM, Macdonald PS. Tricuspid Regurgitation After Heart Transplantation: The Cause or the Result of Graft Dysfunction? Transplantation 2023; 107:1390-1397. [PMID: 36872474 DOI: 10.1097/tp.0000000000004511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common following heart transplantation and has been shown to adversely influence patient outcomes. The aim of this study was to identify causes of progression to moderate-severe TR in the first 2 y after transplantation. METHODS This was a retrospective, single-center study of all patients who underwent heart transplantation over a 6-y period. Transthoracic echocardiogram (TTE) was performed at month 0, between 6 and 12 mo, and 1-2 y postoperatively to determine the presence and severity of TR. RESULTS A total of 163 patients were included, of whom 142 underwent TTE before first endomyocardial biopsy. At month 0, 127 (78%) patients had nil-mild TR before first biopsy, whereas 36 (22%) had moderate-severe TR. In patients with nil-mild TR, 9 (7%) progressed to moderate-severe TR by 6 mo and 1 underwent tricuspid valve (TV) surgery. Of patients with moderate-severe TR before first biopsy, by 2 y, 3 had undergone TV surgery. The use of postoperative extracorporeal membrane oxygenation (ECMO) in the latter group was significant (78%; P < 0.05) as was rejection profile ( P = 0.02). Patients with late progressive moderate-severe TR had a significantly higher 2-y mortality than those who had moderate-severe TR immediately. CONCLUSIONS Overall, our study has shown that in the 2 main groups of interest (early moderate-severe TR and progression from nil-mild to moderate-severe TR), TR is more likely to be the result of significant underling graft dysfunction rather than the cause of it.
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Affiliation(s)
- Nicole K Bart
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of Notre Dame, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Sara L Hungerford
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Mayooran Namasivayam
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Emily Granger
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
| | - Mark Conellan
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
| | - Eugene Kotlyar
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of Notre Dame, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kavitha Muthiah
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Andrew Jabbour
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Christopher Hayward
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Paul C Jansz
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Anne M Keogh
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Peter S Macdonald
- Department of Cardiology, Heart Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Hospital Clinical School, Faculty of Health and Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Gökler J, Aliabadi-Zuckermann AZ, Kaider A, Ambardekar AV, Antretter H, Artemiou P, Bertolotti AM, Boeken U, Brossa V, Copeland H, Generosa Crespo-Leiro M, Eixeré-Esteve A, Epailly E, Farag M, Hulman M, Khush KK, Masetti M, Patel J, Ross HJ, Rudež I, Silvestry S, Suarez SM, Vest A, Zuckermann AO. Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study. Front Cardiovasc Med 2022; 10:879612. [PMID: 35756840 PMCID: PMC9218180 DOI: 10.3389/fcvm.2022.879612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2–8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8–63.1) years, with a median time from transplant to CASH of 4.4 (1–9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8–14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.
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Affiliation(s)
- Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Johannes Gökler,
| | | | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Herwig Antretter
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Alejandro M. Bertolotti
- Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Vicens Brossa
- Heart Transplant Division, Hospital Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Hannah Copeland
- Division Cardiac Surgery, Lutheran Hospital, Indiana University School of Medicine, Indiana, IA, United States
| | - Maria Generosa Crespo-Leiro
- Complejo Hospitalario Universitario a Coruña (CHUAC), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), La Coruña, Spain
| | | | - Eric Epailly
- Heart and Heart-Lung Transplant Unit Medical, Department of Cardiovascular Surgery, Les Hôpitaux Universitaires NHC, Strasbourg, France
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenius University, Bratislava, Slovakia
| | - Kiran K. Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Jignesh Patel
- Heart Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Heather J. Ross
- Cardiac Transplant Program, Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Igor Rudež
- Department of Cardiac Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Scott Silvestry
- Thoracic Transplant Program, AdventHealth Transplant Institute, Florida, FL, United States
| | - Sofia Martin Suarez
- Cardiac Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Orsola, Bologna, Italy
| | - Amanda Vest
- Cardiac Transplantation Program, Tufts Medical Center, Boston, MA, United States
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Abstract
The assessment of pediatric patients after orthotropic heart transplantation (OHT) relies heavily on non-invasive imaging. Because of the potential risks associated with cardiac catheterization, expanding the role of non-invasive imaging is appealing. Echocardiography is fast, widely available, and can provide an accurate assessment of chamber sizes and function. Advanced echocardiographic methods, such as myocardial deformation, have potential to assess for acute rejection or cardiac allograft vasculopathy (CAV). While not currently part of routine care, cardiac magnetic resonance imaging (CMR) and computed tomography may potentially aid in the detection of graft complications following OHT. In particular, CMR tissue characterization holds promise for diagnosing rejection, while quantitative perfusion and myocardial late gadolinium enhancement may have a role in the detection of CAV. This review will evaluate standard and novel methods for non-invasive assessment of pediatric patients after OHT.
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Affiliation(s)
- Jonathan H Soslow
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Margaret M Samyn
- Medical College of Wisconsin, Pediatrics (Cardiology), Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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6
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Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy? Transplant Direct 2017; 3:e209. [PMID: 29138760 PMCID: PMC5627740 DOI: 10.1097/txd.0000000000000725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx. Methods In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution. Results Between March 1984 and October 2016, 17 (1.16%) of 1466 HTx patients underwent cardiac surgery other than retransplantation after HTx. Indication were valvular disease (n = 7), CAV (n = 6), and other (n = 4). Of these, 29.4% (n = 5) were emergency procedures and 70.6% were elective cases. Median age at time of surgery was 61 years (interquartile range, 52-66 years); 82.4% (n = 14) were male. Median time to surgery after HTx was 9.3 years (2.7-11.1 years). In-hospital, mortality was 11.8% (n = 2); later need of retransplantation was 11.8% (n = 2) due to progressing CAV 3 to 9 months after surgery. One-year survival was 82.35%; overall survival was 47.1% (n = 8) with a median follow-up of 1477 days (416-2135 days). Overall survival after emergency procedures was 209 days (36-1119.5 days) whereas, for elective procedures, it was 1583.5 days (901.5-4319 days). Conclusions Incidence of cardiac surgery after HTx in our cohort was low (1.16%) compared with that of other studies. In elective cases, long-term survival was good.
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7
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Kirklin JK, Carlo WF, Pearce FB. Current Expectations for Cardiac Transplantation in Patients With Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2016; 7:685-695. [DOI: 10.1177/2150135116660701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022]
Abstract
Congenital heart disease accounts for 40% of pediatric heart transplants and presents unique challenges to the transplant team. Suitability for transplantation is defined in part by degree of sensitization, pulmonary vascular resistance, and hepatic reserves. The incremental transplant risk for patients with congenital heart disease occurs within the first 3 months, after which survival is equivalent to transplantation for cardiomyopathy. Single ventricle with prior palliation, and especially the failing Fontan, carry the highest risk for transplantation and are least amenable to bridging with mechanical circulatory support. More effective bridging to transplant with mechanical circulatory support will require improvements in the adverse event profile of available pumps and the introduction of miniaturized continuous flow technology. The major barriers to routine long-term survival are chronic allograft failure and allograft vasculopathy. Despite these many challenges, continuing improvements in the care of pediatric heart transplant patients have pushed the median posttransplant survival past 15 years for children and to 20 years for infants.
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Affiliation(s)
- James K. Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar F. Carlo
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama School of Medicine, Birmingham, AL, USA
| | - F. Bennett Pearce
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama School of Medicine, Birmingham, AL, USA
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Ojaghi Haghighi Z, Amin A, Chitsazan M, Taghavi S, Naderi N, Abdollahi M, Mozaffari K. Evaluation of the Role of Conventional and Tissue Doppler Imaging Echocardiography in Detection of Acute Cardiac Allograft Rejection in Heart Transplant Recipients. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(1)35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Jeevanandam V, Russell H, Mather P, Furukawa S, Anderson A, Raman J. Donor Tricuspid Annuloplasty During Orthotopic Heart Transplantation: Long-Term Results of a Prospective Controlled Study. Ann Thorac Surg 2006; 82:2089-95; discussion 2095. [PMID: 17126116 DOI: 10.1016/j.athoracsur.2006.07.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 07/05/2006] [Accepted: 07/07/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Development of tricuspid regurgitation after orthotopic heart transplantation can cause heart failure along with renal and hepatic impairment and portends a poor prognosis. If tricuspid regurgitation causes significant symptoms, tricuspid valve repair or replacement is often required. This study was designed to study the effects of prophylactic tricuspid valve annuloplasty (TVA) during orthotopic heart transplantation on long-term survival, renal function, and amount of tricuspid regurgitation. METHODS Between April 1997 and March 1998, 60 patients (aged 18 to 70 years; 22 female) randomly received either standard bicaval orthotopic heart transplantation (group STD; n = 30) or bicaval orthotopic heart transplantation with DeVega TVA (group TVA; n = 30). Tricuspid valve annuloplasty was performed on the donor heart before implantation using pledgeted 2-0 polypropylene and sized to an annulus of 29 mm. Echocardiographic measurements, laboratory values, and hemodynamics were obtained prospectively and reviewed by an independent data analyst. RESULTS Follow-up of patients as of December 2003 was complete. Although there was a perioperative mortality advantage in group TVA, there was no difference between groups in long-term survival. At the end of the study, however, there was a statistical difference (group STD versus group TVA, p < 0.05) with regard to cardiac mortality (7 of 30 versus 3 of 30), average amount of tricuspid regurgitation (1.5 +/- 1.3 versus 0.5 +/- 0.4), percentage of patients with 2+ or greater tricuspid regurgitation (34% versus 0%), serum creatinine (2.9 +/- 2.0 versus 1.8 +/- 0.7), and difference in serum creatinine over baseline (2.0 +/- 2.1 versus 0.7 +/- 0.8). CONCLUSIONS Prophylactic DeVega TVA of the donor heart is durable and decreases the incidence of cardiac-related mortality and tricuspid regurgitation after orthotopic heart transplantation. In addition, there is improved protection of renal function. Considering the ease and safety of TVA and its advantages, it should be performed as a routine adjunct to orthotopic heart transplantation.
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Kpodonu J, Massad MG, Geha AS. Surgical considerations in the correction of valve dysfunction following heart transplantation. Clin Transplant 2005; 19:694-7. [PMID: 16146564 DOI: 10.1111/j.1399-0012.2004.00316.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Valve dysfunction is not an uncommon occurrence following heart transplantation but when present can be managed medically with diuretics and vasodilator therapy. If medical therapy fails, these patients are considered for retransplantation. Due to the scarcity of donor hearts, efforts aimed at limiting the pool of cardiac retransplantation candidates are being focused lately on preservation of cardiac allograft function by conventional operations in lieu of a retransplant. A review of the literature for patients who underwent valve operations following their heart transplants yielded 26 cases. Four of these had isolated mitral valve procedures, 18 had tricuspid procedures, two had combined mitral and tricuspid operations and two had aortic valve replacements. In this communication, we present a case of severe aortic insufficiency developing 7 yr after heart transplantation and leading to progressive clinical deterioration and NYHA class IV heart failure symptoms. The aortic valve was replaced with a 21-mm Carbo Medics supra-annular mechanical prosthesis (CarboMedics Inc.). She had a favorable postoperative course and remains well 7 months after her operation. Surgical correction of valvular lesions is warranted if the function of the previously transplanted heart is reasonably preserved.
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Affiliation(s)
- Jacques Kpodonu
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA
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11
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Jeevanandam V, Russell H, Mather P, Furukawa S, Anderson A, Grzywacz F, Raman J. A one-year comparison of prophylactic donor tricuspid annuloplasty in heart transplantation. Ann Thorac Surg 2004; 78:759-66; discussion 759-66. [PMID: 15336988 DOI: 10.1016/j.athoracsur.2004.03.083] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND The bicaval technique for orthotopic heart transplantation decreases the incidence of tricuspid valve regurgitation when compared with the standard biatrial technique. This study was designed to study the effects of prophylactic tricuspid valve annuloplasty during bicaval orthotopic heart transplantation on survival, renal function, and amount of tricuspid valve regurgitation. METHODS Between April 1997 and March 1998, 60 patients (age 18 to 70 years, 22 women) randomly received either bicaval orthotopic heart transplantation (n = 30) or bicaval orthotopic heart transplantation with DeVega tricuspid valve annuloplasty (n = 30). Tricuspid valve annuloplasty was performed on the donor heart before implantation using pledgeted 2-0 polypropylene suture and sized to an annulus of 29 mm. Echocardiographic variables, laboratory values, and hemodynamics were obtained prospectively and reviewed by an independent data analyst. RESULTS Intraoperatively, the group undergoing tricuspid valve annuloplasty had a shorter reperfusion time (46 +/- 29 minutes versus 65 +/- 48 minutes; p < 0.05) and higher mean pulmonary artery to central venous pressure difference (11.8 +/- 3.7 mm Hg versus 15.3 +/- 4.1 mm Hg; p = 0.001). Additional differences between the two groups included early mortality from donor dysfunction (4 of 30 patients versus 0 of 30 patients; p < 0.05), amount of tricuspid valve regurgitation at 1 year (1.3 +/- 1.0 versus 0.2 +/- 0.3; p < 0.05), and percentage of patients with 2+ or greater tricuspid valve regurgitation (34% versus 0%; p < 0.05). CONCLUSIONS Tricuspid valve annuloplasty of the donor heart before bicaval orthotopic heart transplantation improves immediate donor heart function as demonstrated by better right ventricular performance, lower perioperative mortality, and shorter reperfusion times. At 1 year, there is less tricuspid valve regurgitation but no difference in renal function. Considering the ease and safety of tricuspid valve annuloplasty and its advantages, it should be performed as a routine adjunct with bicaval orthotopic heart transplantation.
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12
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Kanno S, Wu YJ, Lee PC, Dodd SJ, Williams M, Griffith BP, Ho C. Macrophage accumulation associated with rat cardiac allograft rejection detected by magnetic resonance imaging with ultrasmall superparamagnetic iron oxide particles. Circulation 2001; 104:934-8. [PMID: 11514382 DOI: 10.1161/hc3401.093148] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute cardiac allograft rejection continues to be the cause of graft loss and contributes to the morbidity and mortality after cardiac transplantation. In this study, we report a new method for detecting organ rejection in transplantation with an MR-based technique using dextran-coated ultrasmall superparamagnetic iron oxide (USPIO) particles. These particles ( approximately 27 nm in diameter) are known to shorten relaxation times in MRI experiments. METHODS AND RESULTS A new rat model of heterotopic heart and lung transplantation has been developed for MRI experiments. Allotransplantations (DA-->BN) were performed (n=8), with syngeneic transplantations (BN-->BN) serving as controls (n=8). MR images were obtained with a gradient echo method. At postoperative day 7, allotransplants developed moderate rejection as determined histopathologically. A significant reduction in MR signal intensity was observed after USPIO injection into rats with allotransplanted hearts. Syngeneic transplants showed no differences in MR signal intensity before and after USPIO injections. After injection of USPIO particles at postoperative day 6, a group of allotransplanted rats was treated with cyclosporin A (3 mg/kg). Animals treated with cyclosporin A for 7 days showed no reduction in MR signal intensity after USPIO reinjection at day 14, whereas animals treated for 4 days showed a significant decrease in MR signal intensity in the transplanted hearts indicative of acute graft rejection. Pathological analysis of these animals revealed that dextran-coated USPIO particles were taken up by the infiltrating macrophages that accumulated within the rejecting cardiac graft. CONCLUSIONS This MRI method offers promise as a noninvasive method for detecting transplant allograft rejection.
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Affiliation(s)
- S Kanno
- Department of Biological Sciences and Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, PA 15213-2683, USA
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Chan MC, Giannetti N, Kato T, Kornbluth M, Oyer P, Valantine HA, Robbins RC, Hunt SA. Severe tricuspid regurgitation after heart transplantation. J Heart Lung Transplant 2001; 20:709-17. [PMID: 11448795 DOI: 10.1016/s1053-2498(01)00258-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common after heart transplantation. However, the incidence of severe TR and the incidence of symptoms after echocardiographic diagnosis of severe TR have not been documented. The purpose of this study is to determine the incidence of severe TR and its clinical significance in the heart transplant population. METHODS We reviewed echocardiograms (echo) of all heart transplant patients coming for regular echocardiographic follow-up between 1990 and 1995. We reviewed the charts of all patients who had echo diagnosis of severe TR. RESULTS A total of 336 patients had echo follow-up during this time period. The number of months post-heart transplant to last echo was 54 +/- 50 (range, 1 to 265 months). Ninety patients had moderate TR and 23 patients had severe TR. Mean time from heart transplantation to diagnosis of severe TR was 43 +/- 38 months (range, 1 to 132). Using Cutler-Ederer analysis, at 5 years, 92.2% of surviving patients were free from severe TR. At 10 years, 85.8% of surviving patients were free from severe TR. Of the 23 patients with severe TR, 17 had charts available for review. The mean number of prior endomyocardial biopsies was 28 +/- 21 (range, 3 to 88). These patients were followed for 35 +/- 18 months after diagnosis. During this period, they developed significant heart failure and peripheral edema. Six patients eventually underwent tricuspid valve replacement. CONCLUSIONS Moderate to severe TR commonly occurs following heart transplantation. Severe TR is associated with significant morbidity.
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Affiliation(s)
- M C Chan
- Division of Cardiovascular Medicine, Stanford, California 94305-5247, USA
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Ichikawa S, Takeuchi Y, Suda Y, Ban T, Nunoda S. Tricuspid valve replacement after cardiac transplantation. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:659-62. [PMID: 11080956 DOI: 10.1007/bf03218224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Tricuspid regurgitation, a fairly common finding after cardiac transplantation, is generally mild or moderate, and is not clinically significant. The etiology of tricuspid regurgitation is not entirely understood, and experience with valve replacement after cardiac transplantation is limited. We describe a case of progressively severe tricuspid regurgitation ultimately requiring tricuspid valve replacement. At operation, the ruptured chordae of the posterior part of anterior and septal leaflet with resulting partially flail leaflets were found. Examination of the papillary muscle showed origins of several of the ruptured chordae. Damage to the tricuspid subvalvular apparatus at endomyocardial biopsy appeared to be a possible cause. A 31-mm Carpentier-Edwards porcine valve was implanted. This was because replacement with a mechanical prosthesis would prevent future right-side heart catheterization and endomyocardial biopsy and in valve repair, the patient remains exposed to the risk of the recurrence of chordal rupture. We discuss proposed causes and choices in surgical technique.
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Affiliation(s)
- S Ichikawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Daini Hospital, Japan
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Affiliation(s)
- E R Wijburg
- Department of Cardiopulmonary Surgery and Cardiology, University Hospital Rotterdam Dijkzigt, The Netherlands
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