Right Ventricular Dysfunction and Short‐Term Outcomes Following Left‐Sided Valvular Surgery: An Echocardiographic Study

Abstract

Background The prognostic value of echocardiographic evaluation of right ventricular (RV) function in patients undergoing left‐sided valvular surgery has not been well described. The objective of this study is to determine the role of broad echocardiographic assessment of RV function in predicting short‐term outcomes after valvular surgery. Methods and Results Preoperative echocardiographic data, perioperative adverse outcomes, and 30‐day mortality were analyzed in patients who underwent left‐sided valvular surgery from 2006 to 2014. Echocardiographic parameters used to evaluate RV function include RV fractional area change, tricuspid annular plane systolic excursion, systolic movement of the RV lateral wall using tissue Doppler imaging (S'), RV myocardial performance index, and RV dP/dt. Subjects with at least 3 abnormal parameters out of the 5 aforementioned indices were defined as having significant RV dysfunction. The study included 269 patients with valvular surgery (average age: 67±15, 60.6% male, 148 aortic, and 121 mitral). RV dysfunction was found in 53 (19.7%) patients; 30‐day mortality occurred in 20 patients (7.5%). Compared with normal RV function, patients with RV dysfunction had higher 30‐day mortality (22.6% versus 3.8%; P =0.01) and were at risk for developing multisystem failure/shock (13.2% versus 3.2%; P =0.01). Multivariate analyses showed that preexisting RV dysfunction was the strongest predictor of increased 30‐day mortality (odds ratio: 3.5; 95% CI, 1.1–11.1; P <0.05). Conclusions Preoperative RV dysfunction identified by comprehensive echocardiographic assessment is a strong predictor of adverse outcomes following left‐sided valvular surgery.

The Outcomes of Coronary Artery Bypass Surgery after 18 Months—Is There an Influence of the Initial Right Ventricle Diastolic Dysfunction?

“…In valvular heart surgery, preoperative RV dysfunction was associated with a 3.5-fold increased risk of postoperative 30-day mortality and a 4.2-fold increased risk of multiple postoperative adverse events. In this study, we also used a comprehensive assessment of RV function based primarily on indicators of its systolic function [ 20 ]. Moreover, the initial systolic RV dysfunction led to increased mortality (both total and cardiovascular) during a three-year follow up of patients after heart surgery [ 21 ].…”

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

“…The clinical importance of subclinical RV dysfunction and its association with adverse clinical outcomes has been investigated in different clinical scenarios [ 26 , 27 , 28 , 29 , 30 , 31 ]. In ESLD, RV afterload and preload are affected due to several hemodynamical consequences of advanced liver disease including hyperdynamic circulation, increased pulmonary vascular resistance and increased LV diastolic pressure with a subsequent increase in pulmonary wedge pressure [ 3 , 4 , 5 , 6 , 7 ].…”

A systemic congestive index (systemic pulse pressure to central venous pressure ratio) predicts adverse outcomes in patients undergoing valvular heart surgery

“…8 Specifically, right ventricular function has been shown to be an important prognostic indicator for patients with various cardiac conditions including those undergoing surgery. 22,23 CVP, a proxy for right ventricular function, reflects the right ventricular preload and by extension marks the right ventricular contractile response to afterload imposed on it. Thus a rising CVP signals a compensatory adaptation to right ventricular workload.…”

“…Unfavorable ventricular–ventricular interactions as reflected by a high mean arterial pressure to mPAP ratio have also been associated with increased morbidity and mortality among patients undergoing valvular heart surgery 8 . Specifically, right ventricular function has been shown to be an important prognostic indicator for patients with various cardiac conditions including those undergoing surgery 22,23 . CVP, a proxy for right ventricular function, reflects the right ventricular preload and by extension marks the right ventricular contractile response to afterload imposed on it.…”