What is the clinical evidence from this study?

Study design: Observational. Population: Right ventricular dysfunction after aortic surgery (n=102). Intervention: Elective aortic surgery vs. Preoperative baseline. Primary outcome: Relative percentage change in TAPSE versus FAC (p=0.00027).

What does this research mean for the field?

Elective aortic surgery results in a significantly greater early postoperative reduction in longitudinal right ventricular indices compared to area-based indices, demonstrating that conventional echocardiographic parameters of right ventricular function do not change uniformly. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 16, 2026BMC Surgery0 citationsOpen Access

Differential changes in longitudinal and area-based right ventricular function after aortic surgery: an exploratory echocardiographic study

BABekir Boğaçhan AkkayaIzmir Institute of Technology DSDoğan Emre SertBilkent University MYMehmet Murat YİĞİTBAŞIAnkara University

Key Result

Elective aortic surgery was associated with a significantly greater early postoperative relative reduction in TAPSE (-17.8%) compared to fractional area change (-12.2%).

Key Points

This study aims to assess early postoperative changes in longitudinal and area-based right ventricular function after elective aortic surgery.
Single-center retrospective study with 102 patients undergoing elective aortic surgery.
Preoperative and early postoperative transthoracic echocardiography was performed to evaluate various RV parameters.
The Right Ventricular Functional Dissociation Index was calculated as a descriptive ratio of functional parameters.
TAPSE decreased significantly from 22.0 ± 4.9 mm to 18.3 ± 5.9 mm (p < 0.001).
FAC decreased from 41.9 ± 6.9% to 36.9 ± 7.3% (p < 0.001).
TAPSE showed a greater relative reduction than FAC with -17.8 ± 12.3% vs. -12.2 ± 6.3% (p = 0.00027).

Study Design

Type

Observational (n=102)

Multicenter

Structured PICO

Does elective aortic surgery cause differential changes in longitudinal versus area-based right ventricular function in adult patients?

Population

102 adult patients undergoing elective aortic surgery without severe pre-existing right ventricular dysfunction, evaluated with echocardiography preoperatively and 5-7 days postoperatively.

Exposure

Elective aortic surgery (51 full median sternotomy, 51 minimally invasive right anterior thoracotomy)

Comparator

Preoperative baseline (and exploratory comparison between sternotomy and minimally invasive approaches)

Outcome

Early postoperative changes in longitudinal (TAPSE, S' velocity) and area-based (FAC) right ventricular functional parameterssurrogate

Elective aortic surgery results in a disproportionately greater early postoperative reduction in longitudinal right ventricular indices compared to area-based right ventricular functional change.

Main Result

Absolute Event Rate: -17.8% vs -12.2%

p-value: p=0.00027

Limitations

Single-center retrospective observational study with a modest sample size, which may limit generalizability and introduce selection bias.
Echocardiographic assessment was limited to conventional two-dimensional and tissue Doppler parameters, lacking RV strain, 3D imaging, or MRI.
Fractional area change (FAC) is load-dependent and geometrically limited.
The Right Ventricular Functional Dissociation Index (RV-FDI) is a mathematically derived ratio intrinsically coupled to its component variables.
Multivariable modeling was exploratory and statistically limited by the modest sample size.
Adverse clinical events were infrequent, limiting the assessment of prognostic relevance.

Abstract

Reductions in right ventricular (RV) longitudinal parameters, particularly tricuspid annular plane systolic excursion (TAPSE), are frequently observed after cardiac surgery. However, postoperative changes in longitudinal RV motion may not occur in parallel with other conventional echocardiographic indices of RV function. This study aimed to evaluate early postoperative changes in longitudinal and area-based RV functional parameters after elective aortic surgery. This single-center retrospective study included 102 patients undergoing elective aortic surgery. Preoperative and early postoperative transthoracic echocardiography was used to assess RV function, including TAPSE, fractional area change (FAC), and tissue Doppler-derived S′ velocity. Absolute and relative percentage changes in RV echocardiographic parameters were calculated. To summarize the relative behavior of longitudinal and area-based RV indices, the Right Ventricular Functional Dissociation Index (RV-FDI) was calculated as the ratio of postoperative-to-preoperative FAC to postoperative-to-preoperative TAPSE. RV-FDI was considered an exploratory descriptive ratio and not a validated diagnostic or prognostic marker. TAPSE decreased significantly from 22.0 ± 4.9 mm to 18.3 ± 5.9 mm ( p < 0.001). FAC also decreased significantly from 41.9 ± 6.9% to 36.9 ± 7.3% ( p < 0.001), and S′ velocity declined from 14.9 ± 3.0 cm/s to 12.6 ± 3.5 cm/s ( p < 0.001). The relative reduction in TAPSE was significantly greater than that in FAC (− 17.8 ± 12.3% vs. −12.2 ± 6.3%, p = 0.00027), indicating non-uniform postoperative changes among conventional RV echocardiographic parameters. Mean RV-FDI was 1.09 ± 0.16. No significant differences in postoperative RV parameters or RV-FDI were observed between sternotomy and minimally invasive approaches. RV-FDI was not significantly associated with postoperative lactate levels, inotropic support, mechanical ventilation duration, ICU stay, or hospital stay. Elective aortic surgery was associated with a greater early postoperative reduction in longitudinal RV indices than in FAC, suggesting that conventional echocardiographic parameters of RV function may not change uniformly after surgery. RV-FDI may provide a simple exploratory description of this relative pattern, but it should not be interpreted as a validated measure of RV mechanics, clinical RV dysfunction, or prognosis. Further studies incorporating RV strain, three-dimensional echocardiography, RV–pulmonary arterial coupling, and longitudinal clinical outcomes are required to clarify the physiological and prognostic significance of these findings.

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