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The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

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Abstract

In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984–2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. 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: 1.07, 95% CI (1.02–1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.

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  1. Both authors contributed equally.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Kevin M. Veen, Casper F. Zijderhand, Mostafa M. Mokhles, Jos A. Bekkers, Johanna J. M. Takkenberg & Ad J. J. C. Bogers

  2. Department of Biostatistics, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Grigorios Papageorgiou

  3. Department of Cardiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands

    Jasper J. Brugts, Olivier C. Manintveld, Alina A. Constantinescu & Kadir Caliskan

Authors
  1. Kevin M. Veen
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  2. Grigorios Papageorgiou
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  3. Casper F. Zijderhand
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  4. Mostafa M. Mokhles
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  5. Jasper J. Brugts
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  6. Olivier C. Manintveld
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  7. Alina A. Constantinescu
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  8. Jos A. Bekkers
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  9. Johanna J. M. Takkenberg
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  10. Ad J. J. C. Bogers
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  11. Kadir Caliskan
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Corresponding author

Correspondence to Kadir Caliskan.

Ethics declarations

Kevin M. Veen, Grigorios Papageorgiou, Casper F. Zijderhand, Mostafa M. Mokhles, Jasper J. Brugts, Olivier C. Manintveld, Alina A. Constantinescu, Jos A. Bekkers, Johanna J.M. Takkenberg, Ad J.J.C. Bogers, and Caliskan Kadir declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(s). Informed consent was obtained from all patients for being included in the study.

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Veen, K.M., Papageorgiou, G., Zijderhand, C.F. et al. The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant. Front. Med. 17, 527–533 (2023). https://doi.org/10.1007/s11684-022-0967-5

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  • DOI: https://doi.org/10.1007/s11684-022-0967-5

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