Predicting adverse outcomes after cardiac surgery and structural interventions: the role of right ventricular function

Right ventricular (RV) function is a major determinant of clinical outcomes in patients undergoing cardiac surgery and transcatheter interventions. Although left ventricular morphology and function have been the traditional focus of preprocedural assessment, RV dysfunction is now recognized as an important predictor of morbidity and mortality. Therefore, inclusion of RV-related parameters in preprocedural risk assessment is on the rise. This review summarizes current evidence on the role of RV function in various cardiac diseases that require surgery or interventions. Conventional two-dimensional echocardiographic parameters, such as tricuspid annular plane systolic excursion, RV fractional area change, and peak systolic tissue Doppler velocity, provide limited information due to the complex RV geometry. Advanced imaging techniques, including speckle-tracking, three-dimensional echocardiography, and cardiac magnetic resonance imaging, enable more accurate quantification of RV volumes, ejection fraction, strain, RV motion components and RV-pulmonary artery coupling, and have demonstrated superior prognostic value. Therefore, a comprehensive assessment of RV function using advanced imaging techniques should be incorporated into routine clinical practice to improve risk stratification and preprocedural planning before cardiac surgery and transcatheter interventions. However, it is necessary to standardize imaging protocols and define validated reference thresholds to support the clinical implementation of these state-of-the-art parameters.