Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery

作者：Di Mauro Michele^*; Foschi Massimiliano; Tancredi Fabrizio; Guarracini Stefano; Di Marco Massimo^*; Habib Aly Makram; Kheirallah Hatim; Alsaied Mojtaba; Alfonso Juan J; Gallina Sabina; Calafiore Antonio M

来源：International Journal of Cardiology, 2018, 252: 39-43.

DOI：10.1016/j.ijcard.2017.11.031

• Right ventricular function
• Mitral valve surgery
• Echocardiographic assessment
• Pulmonary hypertension
• Right ventricle

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.

• 出版日期2018-2-1