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Effect Of Cardiac Graft Rejection On Semilunar Valve Function: Implications For Heart Valve Transplantation
Deani McVadon, William Hardy, Katerina Boucek, William Rivers, Jennie Kwon, Minoo Kavarana, John Costello, Taufiek Rajab.
Medical University of South Carolina, Charleston, SC, USA.

Objective(s): Heart valve transplantation is a potential but untested approach to deliver a growing heart valve replacement in children with unrepairable valve disease. The objective of this study was to retrospectively analyze the semilunar valve function of conventional heart transplants during rejection episodes.
Methods: We included pediatric patients who underwent orthotopic heart transplantation at our institution and experienced at least one episode of rejection between 1/1/2010 and 1/1/2020. Semilunar valve function was analyzed using echocardiography at baseline, during rejection and approximately 3 months after rejection.
Results: All patients had either no (27) or trivial (4) aortic insufficiency prior to rejection. One patient developed mild aortic insufficiency during a rejection episode (P=0.73), and all patients had either no (21) or trivial (7) aortic insufficiency at follow-up (P=0.40). All patients had mild or less pulmonary insufficiency prior to rejection, which did not significantly change during (P=0.40) or following rejection (P=0.35). Similarly, compared to maximum pressure gradients across the valves at baseline, which were trivial, there was no appreciable change in the gradient across the aortic valve during (P=0.50) or following rejection (P=0.42), nor was there any meaningful change in the gradient across the pulmonary valve during (P=0.55) or following rejection (P=0.91).
Conclusions: This study demonstrated that there was no echocardiographic evidence of change in semilunar valve function during episodes of rejection in patient with heart transplants. These findings provide partial foundational evidence to justify future research that will determine whether heart valve transplantation may deliver growing heart valve replacements for children.


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