Effect of Preoperative Pulmonary Hypertension on the Course of Right Ventricular Function: A Three-dimensional Echocardiographic Study in Valvular Surgery Patients.

Abstract

Context: Postoperative right heart failure is a poor prognostic factor after cardiac surgery. However, the factors that influence perioperative right ventricular (RV) function remain unknown. This study investigated whether preoperative pulmonary hypertension (PH) affects changes in RV systolic function during the perioperative period.

Aims: This study aimed to determine the effect of preoperative PH on changes in RV systolic function in patients undergoing aortic or mitral valve surgery.

Settings and design: This was a retrospective review of three-dimensional echocardiographic datasets of 157 patients undergoing aortic or mitral valve surgery.

Materials and methods: Patients were classified into the PH (n = 105) or non-PH (n = 51) group based on preoperative right heart catheterization findings. RV ejection fraction and RV longitudinal strain (RVLS) of the free wall and septum were calculated using semiautomated image analysis software at four time points: before surgery, end of surgery, 3 months after surgery, and 1 year after surgery.

Statistical analysis used: A mixed-effects model was used to compare changes in RV function between groups.

Results: Over 1 year, no significant differences in trends were observed between groups for any of the parameters. However, a significant deterioration in free wall RVLS was observed in the non-PH group when focusing on the change from baseline to 1 year (P value for interaction = 0.013).

Conclusions: In patients undergoing valvular surgery, the presence of preoperative PH did not significantly influence changes in RV function throughout the perioperative period.