Predictors of Right Ventricular Systolic Dysfunction After Undergoing Mitral Valvular Surgery

Author : M. A. Callista , A. M. Soesanto, D. A. Juzar, A. Bono
Upload Date : 19-04-2018

Background: In the past decade, studies have shown that patients with right ventricle (RV) dysfunction preoperatively and patients with a decrease in RV function postoperatively have worse mortality and morbidity outcomes. Yet studies evaluating predictors of decreased RV function are still scarce and have never been carried out in Indonesia. This study aims to identify factors such as basic patient characteristics, clinical parameters, preoperative echocardiography data, intraoperative procedure, and postoperative conditions, that may affect the occurence of postoperative RV dysfunction in patients with mitral valve disease undergoing valvular surgery.

Objectives: To identify which factors may predict the occurence of postoperative RV systolic dysfunction in patients with mitral disease undergoing valvular surgery.

Method: This is a case control study taking place in National Cardiovascular Center Harapan Kita (NCCHK). Study subjects are patients who underwent mitral valve surgery in NCCHK from January 2016 until February 2017. Data consisting of basic characteristics, surgical data, echocardiography parameters before and after surgery (predischarge), and intensive care unit integrated records acquired from patient medical records are gathered. Bivariate and multivariate analyses are carried out using the logistic regression method.

Results: 282 patients were included in the study, with 210 patients (75%) having decreased RV systolic function with postoperative TAPSE of <1.6 cm. From multivariate analysis, variables that are statistically significant in predicting decreased RV systolic function postoperatively is tricuspid valve surgery OR 3.29 (P= 0.001, 95% CI 1.65-6.54), duration of ventilator use [OR 4.21 (P=0.001, 95% IC 2.22-7.97)], and routine use of digoxin preoperatively [OR 2.05 (P=0.019 95% IC 1.12-3.99.)].

Conclusion: Tricuspid valve surgery, duration of ventilator use, and routine use of digoxin preoperatively are predictors of postoperative decrease in RV function in patients with mitral disease undergoing valvular surgery.

KEYWORDS : right ventricular function, mitral valve disease, mitral valve surgery, risk factors, predictors

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