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Comparative Study
. 2011 Oct;140(4):1033-1039.
doi: 10.1378/chest.10-2929. Epub 2011 Jun 23.

Combining tricuspid valve repair with double lung transplantation in patients with severe pulmonary hypertension, tricuspid regurgitation, and right ventricular dysfunction

Norihisa Shigemura  1 , Basar Sareyyupoglu  2 , Jay Bhama  2 , Pramod Bonde  2 , Jnanesh Thacker  2 , Christian Bermudez  2 , Cynthia Gries  2 , Maria Crespo  2 , Bruce Johnson  2 , Joseph Pilewski  2 , Yoshiya Toyoda  2
Affiliations
Comparative Study

Combining tricuspid valve repair with double lung transplantation in patients with severe pulmonary hypertension, tricuspid regurgitation, and right ventricular dysfunction

Norihisa Shigemura et al. Chest. 2011 Oct.

Abstract

Background: Concomitant tricuspid valve repair (TVR) and double lung transplantation (DLTx) has been a surgical option at our institution since 2004 in an attempt to improve the outcome of DLTx for end-stage pulmonary hypertension, severe tricuspid regurgitation, and right ventricle (RV) dysfunction. This study is a review of that single institutional experience.

Methods: Consecutive cases of concomitant TVR and DLTx performed between 2004 and 2009 (TVR group, n = 20) were retrospectively compared with cases of DLTx alone for severe pulmonary hypertension without TVR (non-TVR group, n = 58).

Results: There was one in-hospital death in the TVR group. The 90-day and 1- and 3-year survival rates for the TVR group were 90%, 75%, and 65%, respectively, which were not significantly different from those for the non-TVR group. The TVR group required less inotropic support and less prolonged mechanical ventilation in the ICU. Follow-up echocardiography demonstrated immediate elimination of both volume and pressure overload in the RV and tricuspid regurgitation in the TVR group. Notably, there was a significantly lower incidence of primary graft dysfunction following transplantation in the TVR group (P < .05). Pulmonary functional improvement shown by an FEV(1) increase after 6 months was also significantly better in the TVR group (40% vs 20%, P < .05).

Conclusions: Combined TVR and DLTx procedures were successfully performed without an increase in morbidity or mortality and contributed to decreased primary graft dysfunction. In our experience, this combined operative approach achieves clinical outcomes equal or superior to the outcomes seen in DLTx patients without RV dysfunction and severe tricuspid regurgitation.

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Figures

Figure 1.
Figure 1.
Study algorithm. TPG = transpulmonary pressure gradient; TR = tricuspid regurgitation; TVR = tricuspid valve repair; Tx = transplantation.
Figure 2.
Figure 2.
Comparison of patient survival after lung transplant between double lung transplantation concomitant with TVR (TVR group) and without TVR (non-TVR group). See Figure 1 legend for expansion of abbreviation.
See this image and copyright information in PMC

References

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