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

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Reductions in right ventricular (RV) longitudinal parameters, such as tricuspid annular plane systolic excursion (TAPSE), are common post-cardiac surgery.
• Postoperative changes in longitudinal RV motion may not align with other standard echocardiographic RV function indices.

Purpose of the Study:

• To evaluate early postoperative changes in both longitudinal and area-based RV functional parameters following elective aortic surgery.
• To assess the potential utility of a novel Right Ventricular Functional Dissociation Index (RV-FDI) in describing non-uniform RV function changes.

Main Methods:

• A retrospective analysis of 102 patients undergoing elective aortic surgery.
• Preoperative and early postoperative transthoracic echocardiography to assess RV function parameters including TAPSE, fractional area change (FAC), and S' velocity.
• Calculation of the RV-FDI as the ratio of postoperative-to-preoperative FAC to postoperative-to-preoperative TAPSE.

Main Results:

• Significant reductions were observed in TAPSE, FAC, and S' velocity postoperatively (p < 0.001 for all).
• The relative reduction in TAPSE was significantly greater than in FAC (-17.8% vs. -12.2%, p=0.00027), indicating non-uniform changes.
• Mean RV-FDI was 1.09 ± 0.16, with no significant differences between surgical approaches or associations with clinical outcomes.

Conclusions:

• Elective aortic surgery leads to a greater early postoperative reduction in longitudinal RV indices compared to area-based FAC.
• The RV-FDI may offer an exploratory description of this RV functional dissociation but is not a validated clinical marker.
• Further research incorporating RV strain and advanced imaging is needed to understand the physiological and prognostic implications.