Michele Di Mauro1, Massimiliano Foschi2, Fabrizio Tancredi2, Stefano Guarracini3, Massimo Di Marco4, Aly Makram Habib5, Hatim Kheirallah6, Mojtaba Alsaied6, Juan J Alfonso6, Sabina Gallina7, Antonio M Calafiore8. 1. Cardiology and Cardiac Surgery, Madonna del Ponte Institute, Lanciano, Italy. Electronic address: michele.dimauro@univaq.it. 2. Cardiac Surgery, SS Annunziata Hospital, Chieti, Italy. 3. Cardiology, "Pierangeli" Clinic, Pescara, Italy. 4. Cardiology, Civile Hospital, Pescara, Italy. 5. Department of Critical Care, Faculty of medicine, Cairo University, Cairo, Egypt; Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. 6. Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. 7. Cardiology, University of Chieti, Chieti, Italy. 8. Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Cardiac Surgery, Fondazione Giovanni Paolo II, Campobasso, Italy.
Abstract
OBJECTIVE: To evaluate the additive and independent prognostic value of abnormal right ventricle (aRV) and pulmonary hypertension (PH) in patients undergoing mitral-tricuspid surgery. METHODS: From January 2009 to December 2012, 541 patients underwent mitro-tricuspid surgery. The entire cohort was divided into 6 subgroups: 63 cases had normal RV and no PH (Group A), 180 normal RV but moderate PH (Group B), 101 normal RV but severe PH (Group C), 15 abnormal RV and no-PH (Group D), 86 abnormal RV and moderate PH (Group E) and 96 abnormal RV and severe PH (Group F). RESULTS: Forty-two (7.8%) patients died in hospital due to any cause: 1.6% in group A, 3.9% in group B, 8.9% in group C, 13.3% in group D, 9.3% in group E, 15.6% in group E, p = 0.005. Among 78 patients with no-PH, mortality was significantly higher in patients with aRV (1.6%vs 13.3%. p = 0.03). Among 344 patients with normal RV, mortality was significantly higher in patients with severe PH (1.6% vs 3.9% vs 8.9%. p = 0.03). Comparing the presence of both abnormal RV and severe PH with the remaining patients, mortality was significantly higher in the first group (15.6% 6.1%, p = 0.004). Multivariable analysis confirmed either the independent or the additive role of RV and PH. CONCLUSIONS: In patients undergoing mitral-tricuspid valve surgery, the presence of either RV dysfunction/dilatation or severe pulmonary hypertension, might play an independent prognostic role for mortality. The worst scenario is surely the contemporary presence of both conditions.
OBJECTIVE: To evaluate the additive and independent prognostic value of abnormal right ventricle (aRV) and pulmonary hypertension (PH) in patients undergoing mitral-tricuspid surgery. METHODS: From January 2009 to December 2012, 541 patients underwent mitro-tricuspid surgery. The entire cohort was divided into 6 subgroups: 63 cases had normal RV and no PH (Group A), 180 normal RV but moderate PH (Group B), 101 normal RV but severe PH (Group C), 15 abnormal RV and no-PH (Group D), 86 abnormal RV and moderate PH (Group E) and 96 abnormal RV and severe PH (Group F). RESULTS: Forty-two (7.8%) patients died in hospital due to any cause: 1.6% in group A, 3.9% in group B, 8.9% in group C, 13.3% in group D, 9.3% in group E, 15.6% in group E, p = 0.005. Among 78 patients with no-PH, mortality was significantly higher in patients with aRV (1.6%vs 13.3%. p = 0.03). Among 344 patients with normal RV, mortality was significantly higher in patients with severe PH (1.6% vs 3.9% vs 8.9%. p = 0.03). Comparing the presence of both abnormal RV and severe PH with the remaining patients, mortality was significantly higher in the first group (15.6% 6.1%, p = 0.004). Multivariable analysis confirmed either the independent or the additive role of RV and PH. CONCLUSIONS: In patients undergoing mitral-tricuspid valve surgery, the presence of either RV dysfunction/dilatation or severe pulmonary hypertension, might play an independent prognostic role for mortality. The worst scenario is surely the contemporary presence of both conditions.
Entities:
Keywords:
Echocardiographic assessment; Mitral valve surgery; Pulmonary hypertension; Right ventricle; Right ventricular function
Authors: Alina Zubarevich; Marcin Szczechowicz; Andreas Brcic; Anja Osswald; Konstantinos Tsagakis; Daniel Wendt; Bastian Schmack; Michel Pompeu B O Sá; Jef Van den Eynde; Arjang Ruhparwar; Konstantin Zhigalov Journal: J Cardiothorac Surg Date: 2020-11-16 Impact factor: 1.637