Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes

Sharon L. McCartney, Mary Cooter, Zainab Samad, Joseph Sivak, Anthony Castleberry, Stephen Gregory, John Haney, Matthew Hartwig, Madhav Swaminathan

Research output: Contribution to journalArticle

Abstract

Objective Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed. Design A retrospective cohort. Setting A tertiary-care hospital. Participants Patients who underwent OLT between January 1, 2003 and February 4, 2012. Interventions After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant. Measurements and Main Results From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of –0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46). Conclusions This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.

Original languageEnglish
Pages (from-to)924-930
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume31
Issue number3
DOIs
StatePublished - Jun 2017

Keywords

  • lung transplantation
  • mitral incompetence
  • mitral insufficiency
  • mitral regurgitation
  • mitral valve incompetence
  • mitral valve insufficiency
  • mitral valve regurgitation

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    McCartney, S. L., Cooter, M., Samad, Z., Sivak, J., Castleberry, A., Gregory, S., Haney, J., Hartwig, M., & Swaminathan, M. (2017). Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes. Journal of Cardiothoracic and Vascular Anesthesia, 31(3), 924-930. https://doi.org/10.1053/j.jvca.2016.10.025