Can Tricuspid Annuloplasty of the Donor Heart Reduce Valve Insufficiency following Cardiac Transplantation with Bicaval Anastomosis?
| Autor: | Ricardo Ribeiro Dias, Gisele Aparecida Lapenna, Alfredo Inácio Fiorelli, Ronaldo Honorato Barros Santos, Adriana Cristina de Almeida Santos Furlan de Oliveira, Domingos D. Lourenço-Filho, José Luís Oliveira, Noedir Antônio Groppo Stolf, Fernando Bacal, Edimar Alcides Bocchi, G.H.B. Coelho |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Hemodynamics Anastomosis Doppler echocardiography Young Adult Tricuspid Valve Insufficiency medicine Humans Retrospective Studies medicine.diagnostic_test business.industry Anastomosis Surgical Middle Aged Tricuspid insufficiency medicine.disease Surgery Transplantation Catheter Donor heart Echocardiography Heart Transplantation Female Tricuspid Valve Cardiology and Cardiovascular Medicine business Brazil |
| Zdroj: | The Heart Surgery Forum. 13:E168-E171 |
| ISSN: | 1522-6662 1098-3511 |
| Popis: | BACKGROUND The aim of this study was to evaluate the degree of tricuspid valve insufficiency after orthotopic cardiac transplantation with bicaval anastomosis and prophylactic donor heart annuloplasty. METHODS At present, our cardiac transplantation experience includes 478 cases. After January 2002, we included 30 consecutive patients in this study who had undergone orthotopic cardiac transplantation and survived >6 months. The patients were divided into 2 groups: group I, 15 patients who underwent transplantation with prophylactic tricuspid annuloplasty on the donor heart with the De Vega technique; and group II, 15 patients who underwent transplantation without this procedure. Their preoperative clinical characteristics were the same. During the late postoperative follow-up, the degree of tricuspid insufficiency was evaluated by transthoracic Doppler echocardiography and assessed according to the Simpson scale: 0, absent; 1, mild; 2, moderate; and 3, severe. Hemodynamic parameters were evaluated invasively by means of a Swan-Ganz catheter during routine endomyocardial biopsies. RESULTS The mean follow-up time was 26.9 +/- 5.4 months (range, 12-36 months). In group I, 1 patient (6.6%) died from infection in the 18th month after the operation; the death was not related to the annuloplasty. In group II, 1 death (6.6%) occurred after 10 months because of rejection (P > .05). After the 24-month follow-up, the mean degree of tricuspid insufficiency was 0.4 +/- 0.5 in group I and 1.7 +/- 0.9 in group II (P < .05). Similarly, the 2 groups were significantly different with respect to the right atrium pressure, which was higher in group II. CONCLUSIONS Prophylactic tricuspid annuloplasty on the donor heart was able to reduce significantly the degree of valvular insufficiency, even in cardiac transplantation with bicaval anastomosis; however, it did not modify significantly the hemodynamic performance of the allograft during the investigation period. It is very important to extend the observation period and casuistics to verify other benefits that this technique may offer. |
| Databáze: | OpenAIRE |
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