Original article
Right Ventricular Myocardial Performance Index Predicts Perioperative Mortality or Circulatory Failure in High-Risk Valvular Surgery

https://doi.org/10.1016/j.echo.2007.02.017Get rights and content

Background

The prognostic value of right ventricular myocardial performance index (RVMPI) and right ventricular fractional area change (RVFAC) in mitral or aortic valve surgery has not been well described. The main objective of this study is to assess the prognostic value of RVMPI and RVFAC in predicting postoperative mortality or circulatory failure.

Methods

RVMPI and RVFAC were prospectively measured after induction of anesthesia using transesophageal echocardiography in 50 consecutive patients undergoing corrective mitral or aortic valve surgery. Univariate and multivariate analyses were performed for the primary clinical end point of in-hospital mortality or circulatory failure.

Results

In the study population, the mean age was 67 ± 9 years. The primary end point occurred in 17 patients (34%); three patients died, and 14 patients presented signs of circulatory failure. Multivariate regression analysis identified RVMPI and RVFAC as variables of prognostic significance.

Conclusion

Preoperative RVMPI and RVFAC could have an incremental value in predicting postoperative mortality and morbidity in valvular heart surgery. Future studies are needed to validate these results in a larger population.

Section snippets

Patient Selection

After institutional review board approval and written consent, patients undergoing aortic or mitral valve surgery were prospectively assessed. Criteria for inclusion were patients older than 18 years of age and undergoing elective aortic or mitral valve surgery with or without revascularization. Exclusion criteria were (1) atrial fibrillation, (2) significant left to right shunt defined as a Qp/Qs of 1.5 or greater, (3) history of significant RV myocardial infarction, and (4) use of

Results

The clinical characteristics of the study population (27 men and 23 women, age 67 ± 9 years) and the type of surgical interventions are presented in Table 1. PH was present in 34 patients (68%), and the mean Parsonnet score was 20.1 ± 12.4.

Discussion

The main finding of this study is that preoperative RV function assessed by RVMPI or RVFAC could improve the risk stratification of patients undergoing valvular heart surgery. This was further supported by the fact that RVMPI and RVFAC were significantly related to the duration of intensive care unit and hospital stay. Although RVMPI was the only predictive variable in the multivariate model, this does not suggest that RVMPI is the most significant risk factor in valvular heart surgery. It

Conclusion

Preoperative RV function could have an incremental value in the risk stratification of patients undergoing valvular heart surgery. RV adaptation to PH may be a more significant risk factor than the level of PH in valvular surgery. Future studies are, however, needed to validate these results in a larger population and to compare the value of transthoracic and transesophageal measurements of RVMPI and RVFAC.

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Supported in part by the “Fonds de la recherche en santé du Québec” and “Fondation de l’Institut de Cardiologie de Montréal,” Montreal, QC, Canada; Canadian Anesthesiologists’ Society (Abbott Award), Toronto, ON, Canada, and General Electric Health Care (Unrestricted Grant).

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