Title Tricuspid valve regurgitation in heart transplant patients Title (croatian) Trikuspidna regurgitacija u bolesnika nakon transplantacije srca Author Tjaša Dimčić Mentor Boško Skorić (mentor)Committee member Boško Skorić (predsjednik povjerenstva)Committee member Davor Miličić (član povjerenstva)Committee member Maja Čikeš (član povjerenstva)Granter University of Zagreb Defense date and country 2019-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract INTRODUCTION: Tricuspid valve regurgitation (TVR) is a multifactorial and the most common valve disease in cardiac transplant patients. In most cases TVR is mild and with no clinical importance, but some cases of moderate or severe TVR are related with significant morbidity and mortality. It seems that the lowest prevalence of TVR is 3 years after heart transplantation. ----- AIM: To measure the prevalence of TVR after heart transplantation in our patients and its association with different variables related to both the donor and the recipient of the heart transplant. The analysed recipient variables were age, gender, body mass
index, aetiology of heart failure prior to transplantation and pre-transplant hemodynamic status (pulmonary vascular resistance, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and transpulmonary gradient). The donor variables were age and gender. Lastly, we tested an association of ischemic time of the heart and the number of biopsies in post-transplant graft rejection surveillance with the development of TVR. ----- MATERIALS AND METHODS: In this single centre retrospective study we included 135 patients that had undergone heart transplantation in the University Hospital Centre Zagreb in the period between 2008 and 2016, and were followed up for a time period of 3 years by echocardiographic examination. They were divided into those with no or trivial TVR and those with at least mild TVR. These groups were compared according to the above-mentioned variables. The statistical analysis was performed using SPSS statistical software. ----- RESULTS: 23% of the patients were female and 77% were male. The average age of the recipients and donors were 52 and 38, respectively. 53% of the patients had an above normal BMI. The prevalence of mild TVR was 27%, moderate 2% and there was only one patient with severe TVR. The analysis showed no association between donor age and gender with severe TVR. There was also no association of TVR with recipient age, gender, body mass index, aetiology of heart failure prior to transplantation, or pre-transplant hemodynamic status (pulmonary vascular resistance, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and transpulmonary gradient). The average number of biopsies per patient was 15. There was no association between
the number of biopsies in patients with no/trivial and at least mild TVR. ----- CONCLUSION: The prevalence of TVR in our heart transplant patients is very low, with only 2% diagnosed with moderate TVR. We have not found any correlation between the tested variables and TVR despite them being reported in other literature. A possible explanation, besides the relatively low number of patients in the study, is the low number of biopsies and the long sheath technique for taking the biopsies, which spares the tricuspid valve from potential injury.
Abstract (croatian) UVOD: Trikupidna regurgitacija (TR) je multifaktorijalna i najčešća valvularna greška u bolesnika nakon transplantacija srca. U većini slučajeva TR je blaga i klinički neznačajna, ali u nekih je bolesnika umejerena ili teška i povezana sa značajnim simptomima i povećanom smrtnosti. Čini se, da je najmanja pojavnost ove greške u trećoj godini nakon transplantacije. ----- CILJ: Odrediti prevalenciju TR u naših bolesnika nakon transplantacije srca i moguću povezanost ove greške sa nizom varijabli donora i primatelja srčanog presatka. Analizirane varijable primatelja bile su: dob, spol, indeks tjelesne mase, etiologija srčanog popuštanja prije transplantacije i prijetransplantacijski hemodinamski status bolesnika (plućna vaskularna rezistencija, srednji tlak u plućnoj arteriji, okluzivni plućni tlak i transpulmonarni gradijent). Analizirane varijable donora uključivale su dob i spol. Također, ispitali smo moguću povezanost novonastale TR i trajanja ishemije presatka, te ukupnog broja biopsija endomiokarda učinjenih u svrhu detekcije odbacivanja presatka kroz period praćenja. ----- MATERIJALI I METODE: U ovu retrospektivnu studiju uključili smo 135 bolesnika kojima je u period između 2008. i 2016. godine učinjena transplantacija srca u Kliničkom bolničkom centru Zagreb u koji su ultrazvučnu evaluirani nakon tri godine od transplantacije srca. Bolesnike smo podijelili na skupinu bez ili sa trivijalnom TR, i skupinu s minimalno blagom TR. Ove skupine bolesnika su potom uspoređene prema gore navedenim karakteristikama. Statistička analiza učinjena je SPSS softwaru. ----- REZULTATI: Bilo je ukupno 23% ženskih i 77% muških primatelja. Prosječna dob primatelja iznosila je 52 godine, a donora 38 godina. Povišeni BMI našli smo u 53% bolesnika. Pojavnost blage TR iznosila je 27% umjerene TR 2%, dok je samo jedan bolesnik imao tešku TR. Nismo našli povezanosti između TR i starosti ili spola donora. Također, nismo našli povezanosti TR s dobi, spolom, BMI, etiologijom srčanog popuštanja prije transplantacije i prijetransplantacijskim hemodinamskim statusom bolesnika (plućna vaskularna rezistencija, srednji tlak u plućnoj arteriji,
okluzivni plućni tlak i transpulmonalni gradijent). Prosječno je bilo 15 biopsija po bolesniku u navedenom period praćenja. Nije bilo razlike u broju biopsija između bolesnika bez/s trivijalnom TR i bolesnika s minimalno blagom TR. ----- ZAKLJUČAK: Učestalost TR u bolesnika nakon transplantacije srca u našem centru je vrlo niska, sa samo oko 2% bolesnika s barem umjerenom težinom greške. Za razliku od opažanja objavljenih u literaturi nismo našli povezanost niti jedne ispitivane varijable sa TR. Moguće objašnjenje, osim relativno malog broja ispitnika uključenih u ispitivanje, je i u relativno malom broju učinjenih biopsija i tehnici izvođenja biopsije koja koristi dugu uvodnicu pri čemu teoretski smanjuje mogućnost mehaničke ozljede ovog zalistka bioptomom.
Keywords
tricuspid valve regurgitation
heart transplantation
donor
recipient
Keywords (croatian)
trikuspidna regurgitacija
transplantacija srca
donor
primatelj
Language english URN:NBN urn:nbn:hr:105:709580 Study programme Title: Medicine (in English language) Type of resource Text File origin Born digital Access conditions Open access Terms of use Repository Dr Med - University of Zagreb School of Medicine Digital Repository Created on 2020-07-17 10:30:27
