Brazilian Journal of Cardiovascular Surgery (Mar 2008)
Transplante cardíaco com anastomose bicaval e anuloplastia tricúspide profilática no enxerto Cardiac transplantation with bicaval anastomosis and prophylactic graft tricuspid annuloplasty
Abstract
OBJETIVO: O presente estudo tem por objetivo avaliar os efeitos da anuloplastia tricúspide profilática no coração doador em transplante cardíaco com anastomose bicaval. MÉTODOS: De 2002 a 2005, foram selecionados de forma não aleatória 20 pacientes submetidos ao transplante cardíaco pela técnica bicaval e com sobrevida superior a seis meses. Eles foram divididos em dois grupos: Grupo I - 10 pacientes que receberam coração doador com anuloplastia tricúspide profilática, pela técnica de De Vega; e Grupo II - 10 pacientes que não receberam a anuloplastia, ambos com características semelhantes. O grau de regurgitação tricúspide foi avaliado pela ecocardiografia transtorácica com Doppler e foi quantificado entre 0 e 3 (0=ausente, 1=discreto, 2=moderado, 3=grave). O desempenho miocárdico foi avaliado pela fração de ejeção ventricular e pelo estudo hemodinâmico invasivo, durante as biópsias endomiocárdicas de rotina. RESULTADOS: O período médio de observação foi de 14,6±4,3 meses (6 e 16 meses). Houve apenas um óbito no grupo II não relacionado à anuloplastia. O grau médio de regurgitação tricúspide no Grupo I foi de 0,4±0,6 e no Grupo II foi de 1,6±0,8 (p OBJECTIVE: This study aims to evaluate the effects of prophylactic heart donor tricuspid annuloplasty in patients after heart transplantation with bicaval anastomosis. METHODS: From 2002 to 2005, 20 patients undergoing heart transplantation with bicaval anastomosis and with a survival rate over 6 months were deliberately selected. Patients were divided into two groups: Group I - 10 patients who underwent prophylactic heart donor tricuspid annuloplasty by the De Vega technique; and Group II - 10 patients did not undergo annuloplasty. In both groups, presurgical clinical characteristics were the same. The tricuspid regurgitation degree was evaluated by transthoracic Doppler echocardiography and it was qualified from 0 to 3 (0=absent, 1=mild, 2=moderated, 3=severe). Myocardial performance was evaluated by ventricular ejection fraction and invasive hemodynamic study performed during routine endomyocardial biopsies. RESULTS: Mean clinical follow-up was 14.6±4.3 (6 and 16) months. There was only one death in group II. It was not related to annuloplasty. Mean degree of tricuspid regurgitation in Group I was 0.4±0.6 and in Group II was 1.6±0.8 (p < 0.05). There was a statistically significant difference between both groups in right atrium pressure, which was higher in Group II. CONCLUSIONS: In view of the limitations of the study, the prophylactic tricuspid annuloplasty in heart donor reduced the degree of valvar regurgitation in the medium term after heart transplantation with bicaval anastomosis, in spite of not interfering with the allograft hemodynamic performance in the period under consideration.
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