Does significant tricuspid regurgitation early after heart transplantation resolve?

Introduction: In the first few weeks after heart transplantation, it is not unusual to have a moderate to severe tricuspid regurgitation (TR). It is felt that this is due to the distortion of the tricuspid valve annulus and due to volume overload stated. As edema from the heart transplant surgery resolves, the heart may return to its normal size, and therefore, there would be less TR. This has not been validated in clinical studies.
Methods: Between 2010 and 2025, we assessed 362 heart transplant patients immediately after heart transplantation who developed significant moderate to severe TR. Tricuspid valve regurgitation with flail leaflets was excluded from this study. Patients were then monitored for 1, 3, 6, and 12 months post-transplant to assess the degree of TR. Echocardiography parameters were also obtained at these points in time to assess cardiac function, including left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), left atrial diameter (LAD), estimation of pulmonary artery pressure (PAP), and presence of inferior vena cava (IVC) collapse. Patients with moderate to severe TR were 1:1 matched to those without moderate to severe TR of similar age, sex, and transplant date. Clinical outcomes were compared, including 1 and 3-year survival, 1 and 3-year freedom from non-fatal major adverse cardiac events (NF-MACE, including myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter-defibrillator or pacemaker implantation, and stroke), and left ventricular dysfunction (LVD, defined as left ventricular ejection fraction ≤ 40%).
Results: At the 1, 3, 6, and 12-month mark, there’s a trend for a decrease in moderate to severe TR (Figure 1A). LVEDD and LVEF showed no significant differences between the groups during follow-up (Figures 1B and 1C). LAD and estimation of PAP appeared to be lower toward a normal state in the significant TR group (Figures 1D and 1E). The presence of IVC collapse also increased with the improvement of TR. (Figure 1F)

For the clinical outcomes, the significant TR group had similar rates of 1 and 3-year survival, NF-MACE, and LVD compared to case-matched controls. (Figure 2)

Conclusion: Tricuspid valve regurgitation early after heart transplantation resolves over the first 12 months after transplant. Intervention for tricuspid regurgitation is not necessary.