Incremental prognostic value of early postoperative right ventricular systolic function in patients undergoing...

Preoperative right ventricular end-systolic area (RV-ESA) and haemoglobin level have been suggested to be independent predictors of long-term prognosis in patients undergoing corrective surgery for isolated severe tricuspid regurgitation (TR).

To investigate whether early postoperative echocardiography provides useful prognostic information in addition to preoperative clinical and echocardiographic variables.

69 consecutive patients undergoing corrective surgery for isolated severe TR (60 women, mean 57.6±8.9 years) were studied. Comprehensive preoperative echocardiography was performed in all patients, with early postoperative echocardiography in all patients except one. During follow-up (median 40 months, range 6-86 months), clinical events were investigated, defined as operative mortality, cardiovascular death, repeated open heart surgery and readmission due to cardiovascular problems.

28 patients (41%) were categorised as New York Heart Association class II, 36 (52%) as III and 5 (7%) as IV. 63 patients (91.3%) had undergone prior left-sided valve surgery. Seven (10.1%) patients died before discharge. Of the remaining 62 patients, three died during follow-up, and eight required readmission due to cardiovascular problems. On multivariate analyses using clinical and preoperative variables, RV-ESA (p=0.006) and haemoglobin level (p<0.001) were independent predictors of event-free survival. When early postoperative echocardiography variables were included, preoperative haemoglobin and early postoperative RV-FAC were predictors of long-term event-free survival. On receiver-operating characteristic curve analysis, early postoperative RV-FAC≥31% predicted event-free survival with a sensitivity of 90% and a specificity of 83% (p<0.001). The addition of early postoperative echocardiographic RV-FAC markedly improved the prognostic utility of the model containing preoperative haemoglobin level and echocardiographic RV-ESA (p<0.001).

Early postoperative RV-FAC, measured by echocardiography, provided valuable information additional to preoperative RV-ESA and hemoglobin level that was useful for predicting long-term clinical events following corrective TR surgery.