Biological heart valve replacement after heart transplantation

Introduction: A long-term survival of donor organs is necessary in times of organ shortage. The diseased heart valve can severely impair the transplant results. Methods: We performed a retrospective analysis of patients who underwent a biological valve replacement after HTx. Results: Since 1989 we have performed 1381 orthotopic heart transplantations. Biological valve replacement was necessary in 5 patients (3M/2F). The age ranged between 49–68 years with mean 58 years. 3 pt. (2M/1F) received a tricuspid valve (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 tricuspid regurgitation > III° (n=2); emb-related and degenerative changes with a tricuspid regurgitation > III° (n=1); mitral valve-endocarditis (n=1); mitral valve regurgitation IV° secondary to myocardial infarction due to 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 1086–4298/59–2170 days. The follow-up of the 2 survivors was 5340 and 1287 (post-HTx) and 3767 and 1250 days (post valve replacement). Echocardiographic examination was uneventful. There only was evidence of a minor paravalvular leak (tricuspid regurgitation grade I°) 3124 days following TVR with a bioprosthesis. Conclusion: 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.