Risk factors for midterm cardiac function deterioration after valve replacement surgery in patients with rheumatic...

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Postoperative heart failure after valve replacement surgery can occur even with normal preoperative left ventricular ejection fraction (LVEF).
• Rheumatic heart disease (RHD) patients undergoing mitral valve replacement are susceptible to reduced LVEF post-surgery.
• Identifying additional risk factors for reduced LVEF in RHD patients with normal preoperative LVEF is critical.

Purpose of the Study:

• To determine clinical and echocardiographic risk factors for reduced LVEF in RHD patients with normal preoperative LVEF after mitral valve replacement.

Main Methods:

• Retrospective study of 97 RHD patients with severe mitral valve stenosis and normal preoperative LVEF undergoing mitral valve replacement.
• Patients were categorized into normal (Group A) and low (Group B) postoperative LVEF groups at 6 months.
• Multivariate analysis of clinical and echocardiographic data to identify risk factors.

Main Results:

• 15.5% of patients developed low postoperative LVEF despite normal preoperative LVEF.
• Independent risk factors for reduced LVEF included low preoperative systolic peak velocities at the lateral tricuspid annulus (St ≤ 4.8 cm/s) and no or mild aortic stenosis.
• Patients with preoperative St ≤ 4.8 cm/s had a 5.03-fold increased odds of developing lower LVEF post-surgery.

Conclusions:

• Reduced right ventricular function (indicated by tricuspid annular systolic velocity) and mild aortic stenosis are independent predictors of decreased LVEF post-mitral valve replacement in RHD patients.
• Incorporating tricuspid annular systolic velocity into preoperative assessments can enhance postsurgical prognosis and clinical decision-making.