Prevalence and Risk Factors for Tricuspid Valve Regurgitation After Pediatric Heart Transplantation
Received 10 October 2007; received in revised form 29 January 2008; accepted 6 February 2008.
Background
Risk factors for tricuspid regurgitation (TR) after adult orthotopic heart transplantation (OHT) have been reported, although there are no pediatric data.
Methods
This study was a single-center retrospective analysis of patients ≤18 years of age who underwent OHT from January 1990 to December 2004. The impact of TR was evaluated with respect to outcomes (graft failure, etc.).
Results
Echocardiograms were available for 99 patients (105 grafts with 6 re-transplants) at a median age of 4.5 years (range 18 days to 17.1 years): 51 (49%) were male; 46 (44%) were transplanted for congenital heart disease; and 76 (72%) had a biatrial anastomosis. Significant TR developed in 30 grafts (29.5%) within a median duration after OHT of 1.2 years (range 0 day to 8.2 years); persistent significant TR until last follow-up was present in 21 grafts (20%). Graft failure (death or need for retransplantation) occurred in 41 grafts (39%), including 14 of 21 grafts (67%) with significant TR. By Kaplan–Meier analysis, freedom from significant TR (95% confidence interval [CI]) at 1, 5 and 10 years was 91.0% (83.4% to 95.2%), 70.2% (55.4% to 80.9%) and 61.5% (39.2% to 77.6%), respectively. No risk factors were identified. Development of significant TR was highly associated with graft failure (p = 0.005).
Conclusions
Significant TR occurs with comparable frequency in pediatric and adult OHT populations; risk factors identified in adults were not present in our pediatric population. Development of significant TR in pediatric heart transplant recipients is highly associated with graft failure.
Divisions of Cardiac Critical Care and Cardiology, Departments of Critical Care Medicine and Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Reprint requests: V. Ben Sivarajan, MD, Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada. Telephone: 416-813-6477. Fax: 416-813-7299.
ABSTRACT