Abstract 14021: Increased Cardiac Conduction Abnormalities After Tricuspid Annuloplasty During Cardiac Transplantation: A Single Center 3 Year Retrospective Review
Introduction: Tricuspid annuloplasty (TA) performed in donor hearts at time of orthotopic cardiac transplantation to reduce tricuspid regurgitation and preserve right ventricular function in transplant recipients has been shown to improve transplant outcomes. However, after incorporation of TA into our surgical protocol, we have observed an increased incidence of conduction abnormalities including right bundle branch block and heart block suggestive of AV nodal injury after incorporation of TA into the transplant surgical protocol.
Methods: We conducted a retrospective review of medical charts of 97 adult cardiac transplantation recipients, as well as, information available on the donor hearts over a three year time period from 2014 to 2016 at Columbia University Medical Center, New York, NY.
Results: No donor hearts had RBBB prior to harvest. Before vs. after incorporation of the TA procedure into the transplant protocol: the mean age of transplant recipients was 52 ± 1.7 s.e.m years of age vs. 57 ± 1.3 s.e.m years of age. 6 patients (11.8%, n=51) vs. 19 TA patients (42.2%, n=45) had RBBB postoperatively (p<0.005). Development of RBBB was increased in 27 mm (52%) vs 25 mm TA (35%), p=NS. Only 1 recipient (1.9%, n=51) vs. 4 TA recipients (8.8 %, n=45) had complete heart block within 30 days postoperatively (p=0.19), two of whom went on to receive implantation of permanent pacemakers. One of the two patients ultimately recovered AV conduction.
Conclusions: There was a 3.6 fold increase in RBBB and 4.6 fold increase in incidence of AV block after incorporation of TA to the transplant surgical protocol at our center. Our results suggest that TA may cause injury to the conduction system of the donor heart. This is the first retrospective study demonstrating significant conduction abnormalities after incorporation of TA into the transplant surgical protocol.
Author Disclosures: G. Rubin: None. J. Bayne: None. R. Givens: None. M. Noonavath: None. H. Takayama: None. K. Takeda: None. Y. Naka: None. H. Garan: None. M. Farr: None. E. Wan: None.
- © 2016 by American Heart Association, Inc.