Key result
Open-chest mitral valve surgery significantly depressed longitudinal right ventricular function immediately post-procedure, reflected by an absolute reduction in RVEFlong of 7.2%.
Why the study?
Right ventricular function is an important prognostic indicator, but the acute effects of cardiac interventions or cardiac surgery on global and longitudinal right ventricular function are not entirely understood.
Do different cardiac procedures (MVS, PMVR, OPCAB) acutely alter global and longitudinal right ventricular function in adult patients?
Cohort (n=68)
No
Do different cardiac procedures (MVS, PMVR, OPCAB) acutely alter global and longitudinal right ventricular function in adult patients?
Mean Difference: -7.2 (95% CI -9.8–-4.5)
Absolute Event Rate: 13% vs 20%
p-value: p=<0.001
Open-chest mitral valve surgery acutely depresses longitudinal right ventricular function, whereas percutaneous mitral valve repair and off-pump CABG have minimal to no acute impact on these parameters.
Acute longitudinal RV depression after open MVS warrants perioperative monitoring; leaves open prognostic implications requiring prospective validation.
Background Right ventricular (RV) function is an important prognostic indicator. The acute effects of cardiac interventions or cardiac surgery on global and longitudinal RV function are not entirely understood. In this study, acute changes of RV function during mitral valve surgery (MVS), percutaneous mitral valve repair (PMVR) and off-pump coronary artery bypass surgery (OPCAB) were investigated employing 3D echocardiography. Methods Twenty patients scheduled for MVS, 23 patients scheduled for PMVR and 25 patients scheduled for OPCAB were included retrospectively if patients had received 3D transesophageal echocardiography before and immediately after MVS, PMVR or OPCAB, respectively. RV global and longitudinal function was assessed using a 3D multiparameter set consisting of global right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), longitudinal contribution to RVEF (RVEFlong) and free wall longitudinal strain (FWLS). Results Longitudinal RV function was significantly depressed immediately after MVS, as reflected by all parameters (RVEFlong: 20 ± 5% vs. 13 ± 6%,p < 0.001, TAPSE: 13.1 ± 5.1 mm vs. 11.0 ± 3.5 mm,p = 0.04 and FWLS: −20.1 ± 7.1% vs. -15.4 ± 5.1%, p < 0.001, respectively). The global RVEF was slightly impaired, but the difference did not reach significance (37 ± 13% vs. 32 ± 9%,p = 0.15). In the PMVR group, both global and longitudinal RV function parameters were unaltered, whereas the OPCAB group showed a slight reduction of RVEFlongonly (18 ± 7% vs. 14 ± 5%,p < 0.01). RVEFlongyielded moderate case-to-case but good overall reproducibility. Conclusions TAPSE, FWLS and RVEFlongreflect the depression of longitudinal compared to global RV function initially after MVS. PMVR alone had no impact, while OPCAB had a slight impact on longitudinal RV function. The prognostic implications of these phenomena remain unclear and require further investigation.
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Keller et al. (2020) conducted a cohort in Patients undergoing cardiac surgery or interventions (n=68). Open-chest mitral valve surgery (MVS) vs. Pre-procedure baseline was evaluated on Longitudinal contribution to right ventricular ejection fraction (RVEFlong) (MD -7.2%, 95% CI -9.8 to -4.5, p=<0.001). Open-chest mitral valve surgery significantly depressed longitudinal right ventricular function immediately post-procedure, reflected by an absolute reduction in RVEFlong of 7.2%.
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