Tricuspid Valve Regurgitation and Endomyocardial Biopsy After Orthotopic Heart Transplantation

R. J C Chen, J. Wei, C. Y. Chang, Y. C. Chuang, K. C. Lee, S. H. Sue, H. L. Chen

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Abstract

Objective: Tricuspid valve regurgitation (TR) after heart transplantation (HTx) has been reported to be caused by endomyocardial biopsy (EMB), acute cellular rejection (ACR), or atrial anastomosis. We performed a prospective study of this problem among our HTx cohort. Methods: From 1988 to 2006, we performed 274 HTx. Excluding cases within 1 year (2006), there were 178 patients in whom we had records of EMB dates, ACR grades (International Society for Heart and Lung Transplantation [ISHLT], 1990), echocardiography-measured TR, and time-to-TR. Statistical analyses were performed using nonparametric comparisons, Spearman correlation, Kaplan-Meier time to failure curves, and Cox regression model. Results: All 178 patients underwent a biatrial anastomosis and underwent 2631 EMB (median, 15 times per patient; range, 0-42). The median follow-up duration was 66 months (range 2 days-194 months). Up to December 31, 2006, there were 47 patients (47/178 = 26.4%) who developed moderate-to-severe TR, which differed significantly from the prevalence rate (24/39 = 61.5%) reported by another cardiac team (P = .001) that performed bicaval anastomoses in half of the cases (20/39 = 51%). Our 1-, 3-, and 10-year Kaplan-Meier incidence rates of remarkable TR were 14.7% (10.2%-20.8%), 19.4% (14.2%-26.2%), and 36.3% (27.2%-47.3%), respectively. A positive correlation was shown between each patient's EMB times and ACR but not TR grades, in terms of mean, maximum, or minimum over time (all P < .001 for null hypothesis of noncorrelation). Each patient's EMB times and number of definite ACRs (≥ISHLT grade II) did not differ significantly between the two groups of remarkable versus nonremarkable TR. Remarkable TR was negatively predicted by each patient's EMB times (hazard ratio = 0.93; P = .010) but not by the ACR grades or the numbers of definite ACRs. Conclusion: Our cohort demonstrated that biatrial anastomosis, ACR, or EMB were not associated with the risk of remarkable TR. The protective effect of EMB on remarkable TR needs further investigation.

Original languageEnglish
Pages (from-to)2603-2606
Number of pages4
JournalTransplantation Proceedings
Volume40
Issue number8
DOIs
Publication statusPublished - Oct 1 2008
Externally publishedYes

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Tricuspid Valve Insufficiency
Heart Transplantation
Biopsy
Heart-Lung Transplantation
Proportional Hazards Models
Echocardiography
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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Tricuspid Valve Regurgitation and Endomyocardial Biopsy After Orthotopic Heart Transplantation. / Chen, R. J C; Wei, J.; Chang, C. Y.; Chuang, Y. C.; Lee, K. C.; Sue, S. H.; Chen, H. L.

In: Transplantation Proceedings, Vol. 40, No. 8, 01.10.2008, p. 2603-2606.

Research output: Contribution to journalArticle

Chen, R. J C ; Wei, J. ; Chang, C. Y. ; Chuang, Y. C. ; Lee, K. C. ; Sue, S. H. ; Chen, H. L. / Tricuspid Valve Regurgitation and Endomyocardial Biopsy After Orthotopic Heart Transplantation. In: Transplantation Proceedings. 2008 ; Vol. 40, No. 8. pp. 2603-2606.
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abstract = "Objective: Tricuspid valve regurgitation (TR) after heart transplantation (HTx) has been reported to be caused by endomyocardial biopsy (EMB), acute cellular rejection (ACR), or atrial anastomosis. We performed a prospective study of this problem among our HTx cohort. Methods: From 1988 to 2006, we performed 274 HTx. Excluding cases within 1 year (2006), there were 178 patients in whom we had records of EMB dates, ACR grades (International Society for Heart and Lung Transplantation [ISHLT], 1990), echocardiography-measured TR, and time-to-TR. Statistical analyses were performed using nonparametric comparisons, Spearman correlation, Kaplan-Meier time to failure curves, and Cox regression model. Results: All 178 patients underwent a biatrial anastomosis and underwent 2631 EMB (median, 15 times per patient; range, 0-42). The median follow-up duration was 66 months (range 2 days-194 months). Up to December 31, 2006, there were 47 patients (47/178 = 26.4{\%}) who developed moderate-to-severe TR, which differed significantly from the prevalence rate (24/39 = 61.5{\%}) reported by another cardiac team (P = .001) that performed bicaval anastomoses in half of the cases (20/39 = 51{\%}). Our 1-, 3-, and 10-year Kaplan-Meier incidence rates of remarkable TR were 14.7{\%} (10.2{\%}-20.8{\%}), 19.4{\%} (14.2{\%}-26.2{\%}), and 36.3{\%} (27.2{\%}-47.3{\%}), respectively. A positive correlation was shown between each patient's EMB times and ACR but not TR grades, in terms of mean, maximum, or minimum over time (all P < .001 for null hypothesis of noncorrelation). Each patient's EMB times and number of definite ACRs (≥ISHLT grade II) did not differ significantly between the two groups of remarkable versus nonremarkable TR. Remarkable TR was negatively predicted by each patient's EMB times (hazard ratio = 0.93; P = .010) but not by the ACR grades or the numbers of definite ACRs. Conclusion: Our cohort demonstrated that biatrial anastomosis, ACR, or EMB were not associated with the risk of remarkable TR. The protective effect of EMB on remarkable TR needs further investigation.",
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AU - Chen, R. J C

AU - Wei, J.

AU - Chang, C. Y.

AU - Chuang, Y. C.

AU - Lee, K. C.

AU - Sue, S. H.

AU - Chen, H. L.

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N2 - Objective: Tricuspid valve regurgitation (TR) after heart transplantation (HTx) has been reported to be caused by endomyocardial biopsy (EMB), acute cellular rejection (ACR), or atrial anastomosis. We performed a prospective study of this problem among our HTx cohort. Methods: From 1988 to 2006, we performed 274 HTx. Excluding cases within 1 year (2006), there were 178 patients in whom we had records of EMB dates, ACR grades (International Society for Heart and Lung Transplantation [ISHLT], 1990), echocardiography-measured TR, and time-to-TR. Statistical analyses were performed using nonparametric comparisons, Spearman correlation, Kaplan-Meier time to failure curves, and Cox regression model. Results: All 178 patients underwent a biatrial anastomosis and underwent 2631 EMB (median, 15 times per patient; range, 0-42). The median follow-up duration was 66 months (range 2 days-194 months). Up to December 31, 2006, there were 47 patients (47/178 = 26.4%) who developed moderate-to-severe TR, which differed significantly from the prevalence rate (24/39 = 61.5%) reported by another cardiac team (P = .001) that performed bicaval anastomoses in half of the cases (20/39 = 51%). Our 1-, 3-, and 10-year Kaplan-Meier incidence rates of remarkable TR were 14.7% (10.2%-20.8%), 19.4% (14.2%-26.2%), and 36.3% (27.2%-47.3%), respectively. A positive correlation was shown between each patient's EMB times and ACR but not TR grades, in terms of mean, maximum, or minimum over time (all P < .001 for null hypothesis of noncorrelation). Each patient's EMB times and number of definite ACRs (≥ISHLT grade II) did not differ significantly between the two groups of remarkable versus nonremarkable TR. Remarkable TR was negatively predicted by each patient's EMB times (hazard ratio = 0.93; P = .010) but not by the ACR grades or the numbers of definite ACRs. Conclusion: Our cohort demonstrated that biatrial anastomosis, ACR, or EMB were not associated with the risk of remarkable TR. The protective effect of EMB on remarkable TR needs further investigation.

AB - Objective: Tricuspid valve regurgitation (TR) after heart transplantation (HTx) has been reported to be caused by endomyocardial biopsy (EMB), acute cellular rejection (ACR), or atrial anastomosis. We performed a prospective study of this problem among our HTx cohort. Methods: From 1988 to 2006, we performed 274 HTx. Excluding cases within 1 year (2006), there were 178 patients in whom we had records of EMB dates, ACR grades (International Society for Heart and Lung Transplantation [ISHLT], 1990), echocardiography-measured TR, and time-to-TR. Statistical analyses were performed using nonparametric comparisons, Spearman correlation, Kaplan-Meier time to failure curves, and Cox regression model. Results: All 178 patients underwent a biatrial anastomosis and underwent 2631 EMB (median, 15 times per patient; range, 0-42). The median follow-up duration was 66 months (range 2 days-194 months). Up to December 31, 2006, there were 47 patients (47/178 = 26.4%) who developed moderate-to-severe TR, which differed significantly from the prevalence rate (24/39 = 61.5%) reported by another cardiac team (P = .001) that performed bicaval anastomoses in half of the cases (20/39 = 51%). Our 1-, 3-, and 10-year Kaplan-Meier incidence rates of remarkable TR were 14.7% (10.2%-20.8%), 19.4% (14.2%-26.2%), and 36.3% (27.2%-47.3%), respectively. A positive correlation was shown between each patient's EMB times and ACR but not TR grades, in terms of mean, maximum, or minimum over time (all P < .001 for null hypothesis of noncorrelation). Each patient's EMB times and number of definite ACRs (≥ISHLT grade II) did not differ significantly between the two groups of remarkable versus nonremarkable TR. Remarkable TR was negatively predicted by each patient's EMB times (hazard ratio = 0.93; P = .010) but not by the ACR grades or the numbers of definite ACRs. Conclusion: Our cohort demonstrated that biatrial anastomosis, ACR, or EMB were not associated with the risk of remarkable TR. The protective effect of EMB on remarkable TR needs further investigation.

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