Right ventricular dysfunction as a predictor of complicated course in left heart surgery

Abstract

Aim. To analyze the right ventricular (RV) functionality in a cohort of heterogeneous cardiac surgical patients with left-sided valvular heart disease and determine the contribution of RV dysfunction in the complicated postoperative period according to echocardiography.Material and methods. A single-center prospective study of patients with left heart defects operated on in 2022 was conducted. Age ranged was 20-81 years, with a median age of 58 years. The study was conducted on a PHILIPS EPIQ CVx system using an X5-1 probe.Results. To estimate the risk of a complicated postoperative period depending on various indicators of RV systolic function assessment, ROC-analysis was performed. The ROC curve of the RV free wall longitudinal strain (RV FW LS) was characterized by the highest AUC value among other RV functional measures, equal to 0,81±0,06 (95% confidence interval (CI): 0,68-0,93), p<0,001. A value of 20% was selected as the cut-off point of RV FW LS for predicting a complicated postoperative period. The RV FW LS <20% was 19,2 times more likely to develop a complicated course (95% CI: 5,64 to 65,50), compared with the RV FW LS group ≥20%; p<0,05. The odds of heart failure (HF) in the RV FW LS <20% group were 22,78 times higher (95% CI: 5,90 to 88,04), compared with the RV FW LS ≥20% group; p<0,05.Conclusion. The RV FW LS <20% can be considered an independent predictor of complicated postoperative period with a multiple increase in the risk of complications, mainly the risk of heart failure. The assessment of RV FW LS can significantly help in risk stratification, being the reason for the reclassification of a number of patients in the high-risk group with a possible modification of surgical strategy.

Keywords

• speckle-tracking echocardiography
• right ventricle
• predictor of com­pli­cated course
• right ventricular dysfunction
• longitudinal strain
• left heart cardiac surgery