Background. The aim of this retrospective study is to evaluate whether right ventricular dilatation and/or dysfunction might affect early cardiac mortality of patients with ischemic mitral regurgitation (IMR) undergoing mitral valve surgery (MVS). Methods. From March 2006 to May 2008, 103 patients with IMR, electively operated on by a single surgeon (AMC), were enrolled in the study. Patients with severe tricuspid regurgitation were excluded from the study due to misleading assessment of tricuspid annular plane systolic excursion (TAPSE); the last item was used to evaluate RV function. Diastolic RV diameter was also evaluated. The primary end-point was early cardiac mortality. All the analyses were validated in 1000 bootstrap samples. Results. Ten patients (9.7%) died within 30 days from the operation due to cardiac causes. Right ventricular diameter (RVD) was inversely correlated to TAPSE (r=-0.349). Logistic regression was performed including either RVD or TAPSE separately. Lower TAPSE was a risk factor for increased early cardiac mortality (OR=0.76, 95%CL=0.56-0.96) regardless of tricuspid surgery. To determine cut-off value of TAPSE, ROC curve analysis was performed: TAPSE (AUC=0.75) with a cutoff of 15mm (sensitivity=80%, specificity=78.5%, OR=14.5) Conclusions. In presence of dysfunctioning RV, the likelihood of cardiac death increases, especially if TAPSE is equal or lower than 15 mm. In this specific group, intraoperative both, invasive and non invasive monitoring, is strongly suggested in order to assess and reduce not only left ventricular dysfunction but also to prevent worsening of the right ventricular impairment. Moreover, in case of high pulmonary pressure, selective pulmonary bed vasodilators should be employed to reduce right ventricular afterload. Finally, urine output should be kept unaltered to avoid a volume overload of right ventricular. This study confirm our belief that is clearly the time to move towards a reconsideration of the commonplace assumptions of cardiac surgery about the importance of the RV function and its correlation with the patient’s surgical outcomes.
Carlo Di Lorenzo, M.D., Assunta Fabozzo, M.D., Mohammed A. Khan, M.D., et al. (2013). The Impact of Right Ventricle Upon Early Cardiac Mortality of Patients With Ischemic Mitral Regurgitation Undergoing Mitral Valve Surgery.
The Impact of Right Ventricle Upon Early Cardiac Mortality of Patients With Ischemic Mitral Regurgitation Undergoing Mitral Valve Surgery
FABOZZO, ASSUNTA;
2013
Abstract
Background. The aim of this retrospective study is to evaluate whether right ventricular dilatation and/or dysfunction might affect early cardiac mortality of patients with ischemic mitral regurgitation (IMR) undergoing mitral valve surgery (MVS). Methods. From March 2006 to May 2008, 103 patients with IMR, electively operated on by a single surgeon (AMC), were enrolled in the study. Patients with severe tricuspid regurgitation were excluded from the study due to misleading assessment of tricuspid annular plane systolic excursion (TAPSE); the last item was used to evaluate RV function. Diastolic RV diameter was also evaluated. The primary end-point was early cardiac mortality. All the analyses were validated in 1000 bootstrap samples. Results. Ten patients (9.7%) died within 30 days from the operation due to cardiac causes. Right ventricular diameter (RVD) was inversely correlated to TAPSE (r=-0.349). Logistic regression was performed including either RVD or TAPSE separately. Lower TAPSE was a risk factor for increased early cardiac mortality (OR=0.76, 95%CL=0.56-0.96) regardless of tricuspid surgery. To determine cut-off value of TAPSE, ROC curve analysis was performed: TAPSE (AUC=0.75) with a cutoff of 15mm (sensitivity=80%, specificity=78.5%, OR=14.5) Conclusions. In presence of dysfunctioning RV, the likelihood of cardiac death increases, especially if TAPSE is equal or lower than 15 mm. In this specific group, intraoperative both, invasive and non invasive monitoring, is strongly suggested in order to assess and reduce not only left ventricular dysfunction but also to prevent worsening of the right ventricular impairment. Moreover, in case of high pulmonary pressure, selective pulmonary bed vasodilators should be employed to reduce right ventricular afterload. Finally, urine output should be kept unaltered to avoid a volume overload of right ventricular. This study confirm our belief that is clearly the time to move towards a reconsideration of the commonplace assumptions of cardiac surgery about the importance of the RV function and its correlation with the patient’s surgical outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
