• Sharon L McCartney, Mary Cooter, Zainab Samad, Joseph Sivak, Anthony Castleberry, Stephen Gregory, John Haney, Matthew Hartwig, and Madhav Swaminathan.
• Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC. Electronic address: Sharon.McCartney@duke.edu.
• J. Cardiothorac. Vasc. Anesth. 2017 Jun 1; 31 (3): 924-930.

ObjectiveProgression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed.DesignA retrospective cohort.SettingA tertiary-care hospital.ParticipantsPatients who underwent OLT between January 1, 2003 and February 4, 2012.InterventionsAfter receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant.Measurements And Main ResultsFrom 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46).ConclusionsThis study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.Copyright © 2017 Elsevier Inc. All rights reserved.

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