Preoperative right ventricular dysfunction is a strong predictor of 3 years survival after cardiac surgery

Prognostic value of right ventricular (RV) systolic function is well established in valvular disease, heart failure but has not been evaluated in patients undergoing cardiac surgery.

The aim of the present study was to evaluate the prognostic value of preoperative RV dysfunction extensively evaluated on the basis of a large set of echocardiographic parameters [S', RV fractional area change (RVFAC), right myocardial performance index (RMPI), isovolumic acceleration (IVA), RV dP/dt and basal longitudinal strain (BLS)] in a large population of unselected patient awaiting cardiac surgery.

We prospectively studied 400 consecutive patients referred for cardiac surgery, in a single surgical center. Echocardiography was performed 24 h before surgery and phone interview assessed the survival status (overall and cardiovascular death) 3-years after surgery.

Among 400 patients, 271 were male, mean age was 70.3 ± 10.2. At 3-years the overall and cardiovascular mortality was, respectively, 10.5 and 6.8%. The univariate Cox analysis identified all RV function parameters excepted BLS as predictive factors of overall mortality, with the strongest value for RVFAC < 35% (HR 4.8), S' < 10 cm/s (HR 3.8) and IVA < 1.8 m/s² (HR 3.2) (all P < 0.001). All parameters were associated to cardiovascular mortality. In multivariate analysis, RVFAC, S', dP/dt and IVA were significantly associated to 3-years overall mortality whatever the EuroSCORE. Abnormal RVFAC, S', IVA and BLS were associated to cardiovascular mortality.

The presence of RV dysfunction before cardiac surgery assessed by echo significantly predicts postoperative mortality, and this is true whatever the EuroSCORE level. This result demonstrates the need of adding the assessment of echographic RV function before cardiac surgery.