Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes.


OBJECTIVE: Progression 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. DESIGN: A retrospective cohort. SETTING: A tertiary-care hospital. PARTICIPANTS: Patients who underwent OLT between January 1, 2003 and February 4, 2012. INTERVENTIONS: After 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 RESULTS: From 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). CONCLUSIONS: This 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.





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Publication Info

McCartney, Sharon L, Mary Cooter, Zainab Samad, Joseph Sivak, Anthony Castleberry, Stephen Gregory, John Haney, Matthew Hartwig, et al. (2017). Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes. J Cardiothorac Vasc Anesth, 31(3). pp. 924–930. 10.1053/j.jvca.2016.10.025 Retrieved from

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Sharon Lorraine McCartney

Associate Professor of Anesthesiology

Zainab Samad

Adjunct Associate Professor in the Department of Medicine

Dr. Zainab Samad is chairwoman of the Department of Medicine at Aga Khan University (AKU) in Pakistan and currently serves as an Adjunct Associate Professor of Medicine at Duke University. 

She attended Medical School at the Aga Khan University Medical College in Karachi, Pakistan and thereafter completed her residency training in Internal Medicine and fellowship in Cardiology at Duke University Medical Center in Durham, North Carolina. Additionally, she completed advanced training in cardiovascular imaging, specifically in clinical echocardiography, cardiac MRI and SPECT-myocardial perfusion imaging. She is also trained in quantitative methods with a Master of Health Sciences in Clinical Research degree from the National Institutes of Health- Duke Clinical Research Training Program. She served on faculty in the Division of Cardiology, Department of Medicine for nine years before accepting the position at AKU in 2018. She resides full-time in Karachi.


Matthew Hartwig

Professor of Surgery

Dr. Hartwig is a thoracic surgeon with a clinical focus in lung transplantation and robotic assisted minimally invasive thoracic surgery for the treatment of diseases of the chest.  He serves as the Surgical Director of the Duke Lung Transplant Program and the Esophageal Center at Duke.  Additionally, he directs the Surgical Office of Clinical Research, which manages the clinical research portfolio for the Department of Surgery.  He also leads a successful program of clinical, basic and translational research in thoracic surgery and lung transplantation. He currently directs the Duke Ex Vivo Organ Laboratory (DEVOL), is the Chief of Lung Transplant Research, and is a faculty member at the Duke Clinical Research Institute (DCRI).

Dr. Hartwig has over 150 peer reviewed publications, received numerous awards, chaired many sessions at national and international meetings, serves regularly on NIH study sections, and is on the editorial board of many prominent journals. He has also personally mentored over pre-and post-doctoral trainees, many of whom are now engaged in their own successful research careers.


Madhav Swaminathan

Professor of Anesthesiology

My overall goal is to elucidate mechanisms of and risk factors for perioperative acute kidney injury in patients undergoing heart surgery with emphasis the role of early recovery of kidney function. A special area of interest is the phenomenon of left ventricular diastolic dysfunction. We have successfully developed an algorithm to help simplify the detection of diastolic dysfunction using echocardiography during heart surgery. A future goal is to explore interventions that help prevent or reduce the severity of diastolic dysfunction postoperatively.

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