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

Reductions in right ventricular (RV) longitudinal parameters, particularly tricuspid annular plane systolic excursion (TAPSE), are frequently observed after cardiac surgery. However, postoperative changes in longitudinal RV motion may not occur in parallel with other conventional echocardiographic indices of RV function. This study aimed to evaluate early postoperative changes in longitudinal and area-based RV functional parameters after elective aortic surgery.

This single-center retrospective study included 102 patients undergoing elective aortic surgery. Preoperative and early postoperative transthoracic echocardiography was used to assess RV function, including TAPSE, fractional area change (FAC), and tissue Doppler-derived S' velocity. Absolute and relative percentage changes in RV echocardiographic parameters were calculated. To summarize the relative behavior of longitudinal and area-based RV indices, the Right Ventricular Functional Dissociation Index (RV-FDI) was calculated as the ratio of postoperative-to-preoperative FAC to postoperative-to-preoperative TAPSE. RV-FDI was considered an exploratory descriptive ratio and not a validated diagnostic or prognostic marker.

TAPSE decreased significantly from 22.0 ± 4.9 mm to 18.3 ± 5.9 mm (p < 0.001). FAC also decreased significantly from 41.9 ± 6.9% to 36.9 ± 7.3% (p < 0.001), and S' velocity declined from 14.9 ± 3.0 cm/s to 12.6 ± 3.5 cm/s (p < 0.001). The relative reduction in TAPSE was significantly greater than that in FAC (- 17.8 ± 12.3% vs. -12.2 ± 6.3%, p = 0.00027), indicating non-uniform postoperative changes among conventional RV echocardiographic parameters. Mean RV-FDI was 1.09 ± 0.16. No significant differences in postoperative RV parameters or RV-FDI were observed between sternotomy and minimally invasive approaches. RV-FDI was not significantly associated with postoperative lactate levels, inotropic support, mechanical ventilation duration, ICU stay, or hospital stay.

Elective aortic surgery was associated with a greater early postoperative reduction in longitudinal RV indices than in FAC, suggesting that conventional echocardiographic parameters of RV function may not change uniformly after surgery. RV-FDI may provide a simple exploratory description of this relative pattern, but it should not be interpreted as a validated measure of RV mechanics, clinical RV dysfunction, or prognosis. Further studies incorporating RV strain, three-dimensional echocardiography, RV-pulmonary arterial coupling, and longitudinal clinical outcomes are required to clarify the physiological and prognostic significance of these findings.