Heart valve replacement after orthotopic heart transplantation: Indications, risks, results

A long-term survival of donor organs is paramount in times of organ shortage. The diseased heart valve can severely impair the transplant results. We performed a retrospective analysis of patients who underwent a valve replacement after HTx. Since 1989 we have performed 1381 orthotopic heart transplantations. A valve replacement was mandated in seven patients (5M/2F). The patient's ages ranged between 48–74 years with mean 58 years. 5 pt. (4M/1F) received a tricuspid valve (2 SJM-alloprosthesis; 3 bioprothesis: Aspire 1; Biocor 2), 2 pt. (1M/1F) received a mitral valve (2 Hancock-bioprothesis). The indications were: endomyocardial biopsy (emb)-related damages to the tricuspid valve with a tricuspid regurgitation > III° (n=4); emb-related and degenerative changes with a tricuspid regurgitation > III° (n=1); mitral valve-endocarditis (n=1); mitral valve regurgitation IV° secondarily to a myocardial infarction due to a progressing graft vasculopathy (n=1). The time of survival (after HTx/after valve replacement) of the three expired pt.'s (2 tricuspid valve replacements/1 MVR) ranged between 2927–6073/59–2151 days. The follow-up interval of the survivors ranged between 608–4769/570–849 days. Echocardiographic examination was uneventful. There was echocardiographic evidence of a minor paravalvular leak (tricuspid regurgitation grade I°) 3124 days following TVR with a bioprosthesis. A diseased heart valve after HTx can sufficiently and safely be treated with a valve replacement. A bioprosthesis is also a good option- and achieves good long-term results. Thus, we consider valve replacement as a feasible means to treat heart transplant recipients and to improve graft and patient survival.