TY - JOUR
T1 - Right ventricular dysfunction after surgical left ventricular restoration
T2 - Prevalence risk factors and clinical implications
AU - Couperus, Lotte E.
AU - Delgado, Victoria
AU - van Vessem, Marieke E.
AU - Tops, Laurens F.
AU - Palmen, Meindert
AU - Braun, Jerry
AU - Verwey, Harriëtte F.
AU - Klautz, Robert J.M.
AU - Schalij, Martin J.
AU - Beeres, Saskia L.M.A.
N1 - Publisher Copyright: © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017/12
Y1 - 2017/12
N2 - OBJECTIVES: Surgical left ventricular (LV) restoration (SVR) induces changes in LV systolic and diastolic function that may affect postoperative right ventricular (RV) function. This study aimed to evaluate the long-term effect of SVR on RV function, with specific focus on determinants and prognostic implications of RV dysfunction. METHODS: Eighty-six patients (age 60 ± 10 years, 73% male) with clinical and echocardiographic follow-up 2 years after SVR were included. RV dysfunction was defined as RV fractional area change < 35%. The association between RV dysfunction at follow-up and clinical and echocardiographic characteristics and outcome was investigated. RESULTS: RV dysfunction at follow-up was present in 40% of patients and was associated with worse preoperative RV fractional area change (39 ± 9 vs 46 ± 7%, P < 0.01), pulmonary hypertension (18 vs 4%, P= 0.03) and higher follow-up LV filling pressures (E/E' ratio 23± 8 vs 15± 8, P=0.02). At follow-up, patients with RV dysfunction were more frequently in New York Heart Association Class III or IV (30 vs 12%, P= 0.04) and 5-yearmortality, heart transplantation and LV assist device implantation rate was increased (49 vs 17%, P < 0.01) as compared to patients with normal RV function. CONCLUSIONS: RV dysfunction after SVR was observed in 40% of patients and was associated with preoperative RV dysfunction, presence of pulmonary hypertension and an increase in LV filling pressures at follow-up. Patients with RV dysfunction after SVR had worse clinical functioning and outcome as compared to patients with normal RV function.
AB - OBJECTIVES: Surgical left ventricular (LV) restoration (SVR) induces changes in LV systolic and diastolic function that may affect postoperative right ventricular (RV) function. This study aimed to evaluate the long-term effect of SVR on RV function, with specific focus on determinants and prognostic implications of RV dysfunction. METHODS: Eighty-six patients (age 60 ± 10 years, 73% male) with clinical and echocardiographic follow-up 2 years after SVR were included. RV dysfunction was defined as RV fractional area change < 35%. The association between RV dysfunction at follow-up and clinical and echocardiographic characteristics and outcome was investigated. RESULTS: RV dysfunction at follow-up was present in 40% of patients and was associated with worse preoperative RV fractional area change (39 ± 9 vs 46 ± 7%, P < 0.01), pulmonary hypertension (18 vs 4%, P= 0.03) and higher follow-up LV filling pressures (E/E' ratio 23± 8 vs 15± 8, P=0.02). At follow-up, patients with RV dysfunction were more frequently in New York Heart Association Class III or IV (30 vs 12%, P= 0.04) and 5-yearmortality, heart transplantation and LV assist device implantation rate was increased (49 vs 17%, P < 0.01) as compared to patients with normal RV function. CONCLUSIONS: RV dysfunction after SVR was observed in 40% of patients and was associated with preoperative RV dysfunction, presence of pulmonary hypertension and an increase in LV filling pressures at follow-up. Patients with RV dysfunction after SVR had worse clinical functioning and outcome as compared to patients with normal RV function.
KW - Heart failure
KW - Right ventricular function
KW - Surgical left ventricular restoration
UR - http://www.scopus.com/inward/record.url?scp=85045011014&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045011014&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/28655192
U2 - https://doi.org/10.1093/EJCTS/EZX201
DO - https://doi.org/10.1093/EJCTS/EZX201
M3 - Article
C2 - 28655192
SN - 1010-7940
VL - 52
SP - 1161
EP - 1167
JO - European journal of cardio-thoracic surgery
JF - European journal of cardio-thoracic surgery
IS - 6
ER -