Functional tricuspid valve insufficiency after cardiac transplantation: Which factor is the most important?

Abstract Objectives Tricuspid insufficiency (TI) is the most common valvular complication following orthotopic heart transplantation (HTx) and in serious cases is associated with increased mortality. In this study we analyze the possible variables influencing TI following HTx and aim to identify the most important risk factors and mechanisms responsible for functional TI development and progression. Methods We identified the incidence of tricuspid insufficiency within our institute in 857 of 1515 patients who underwent HTx using the biatrial anastomosis technique in the years between 1986 and 2010. The risk factors that can influence tricuspid insufficiency were retrospectively analyzed in detail in a representative group of 152 patients with identical TI distribution as found in the entire program. Patients of the group were subdivided into two groups according to the severity of TI: patients with TI grade ≤2 and those with TI grade >2. Impact on long-term survival (> 15 years) was assessed. Results In univariable analysis, study variables such as age of recipient (p=0.027), donor to recipient right atrium anterior wall ratio (p Conclusions Changes in tricuspid annulus geometry, number of biopsies, and dialysis are the most important risk factors for the development and progression of tricuspid insufficiency following cardiac transplantation. It could be prevented using modified operative techniques, utilizing non-invasive diagnostic modalities and using intensified ultrafiltration. In patients with biatrial anastomosis technique with generous atrial cuff, presence of TI > grade 2 did not impact long-term survival.