Background
Problematic mitral regurgitation (MR) may develop following lung transplantation (LTx).
There is limited information on the management of MR in LTx patients, as such we sought
to evaluate our centre’s experience.
Methods
From 2000 to 2019, 1,054 patients underwent LTx at our centre (896 bilateral, 158
single). We identified patients in whom significant MR developed at any point post-LTx.
The aetiology of MR, management and outcome were retrospectively analysed.
Results
Eight (8) patients developed severe MR post-LTx, six following bilateral LTx and two
following single LTx. Lung transplantation indications included interstitial lung
disease (n=5), chronic obstructive pulmonary disease (n=2) and pulmonary arterial
hypertension (n=1). Severe MR occurred intraoperatively (n=1), postoperative day 1
(n=1) with the remaining six cases between 80 and 263 days post-LTx. The aetiology
was noted to be due to severe left ventricular dysfunction following unmasking of
a chronically pulmonary hypertension-related under-preloaded left ventricle in one
case, and in the remaining seven patients causes included myxomatous degeneration,
ischaemic MR, and functional MR due to annular dilatation. In the patient with intraoperative
severe MR, the MR became mild with veno-arterial extracorporeal membrane oxygenation
(VA-ECMO) and in the remaining seven patients a variety of procedures were used, including
mitral valve repair, valve replacement and transcatheter edge-to-edge mitral valve
repair. All patients survived the mitral procedure. Two (2) deaths occurred at 12.9
years (stroke) and 5 years (cancer) from mitral valve surgery.
Conclusions
Development of significant mitral valve regurgitation is a rare but morbid complication
after lung transplantation. This may represent the progressive natural history of
pre-existing degenerative mitral valve disease and rarely, early after transplantation
may be related to changes in ventricular geometry. Management of severe MR can follow
the same management approach as in the non-transplant community, with the expectation
of similarly good results.
Keywords
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References
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Article info
Publication history
Published online: November 24, 2021
Accepted:
October 17,
2021
Received in revised form:
August 16,
2021
Received:
April 23,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
