Changes in Right Ventricle Function After Mitral Valve Repair Surgery

Sam R. Orde, Sheng Ying Chung, Juan N. Pulido, Rakesh M. Suri, John M. Stulak, Jae Kuen Oh, Sorin V. Pislaru, Hector M. Michelena, Richard C. Daly, Garvan M Kane

Research output: Contribution to journalArticle

Abstract

Background: Right ventricular (RV) dysfunction can occur after cardiac surgery and persist for years. We assessed perioperative RV systolic function in patients undergoing mitral valve (MV) repair and further compared minimally invasive robotic-assisted mitral valve repair (MIMVr) vs standard ‘open’ MV repair (MVr). Speckle tracking (RV free wall strain [RVS]) was used as a sensitive echocardiography method to assess RV function. Methods: Retrospective analysis, over 3 years, of consecutive patients (n = 158) referred to Mayo Clinic (Rochester, MN, USA). Preoperative, pre-discharge and 1 year transthoracic echocardiograms were reviewed. A prospective pilot study was performed for sample size estimation. Primary outcome was RV free wall strain (RVS). Results: Right ventricular free wall strain declined after MV repair surgery (-22.6 ± 7% vs -15 ± 6%, p < 0.001). There were smaller reductions in RVS in MIMVr vs MVr group (-6.0 ± 9% vs -10.3 ± 8%, p < 0.01), which persisted after adjusting for baseline values (RVS treatment effect 1.5%, p = 0.007). There was greater recovery in MIMVr vs MVr group at 1 year follow-up vs pre-surgery values (-3.4 ± 9% vs -8.1 ± 8% respectively, p < 0.001, RVS treatment effect 1.7%, p = 0.001). Bypass time was higher in the MIMVr group (80 min ± 22 vs 40 min ± 20, p < 0.0001). The echo findings remained significant correcting for age, pulmonary pressures and change in ejection fraction. Conclusions: Right ventricular systolic dysfunction is common after MV repair surgery. Deterioration in RV contraction is less pronounced following MIMVr vs MVr and is associated with enhanced RV functional recovery at 1 year, albeit not to preoperative levels. This may potentially be associated with clinical functional improvement but further studies are warranted to investigate this.

Original languageEnglish (US)
JournalHeart Lung and Circulation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Mitral Valve
Heart Ventricles
Robotics
Right Ventricular Dysfunction
Right Ventricular Function
Sample Size
Thoracic Surgery
Echocardiography
Prospective Studies
Pressure
Lung
Therapeutics

Keywords

  • Echocardiography
  • Mitral valve repair
  • Right ventricle
  • Speckle tracking
  • Strain

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Changes in Right Ventricle Function After Mitral Valve Repair Surgery. / Orde, Sam R.; Chung, Sheng Ying; Pulido, Juan N.; Suri, Rakesh M.; Stulak, John M.; Oh, Jae Kuen; Pislaru, Sorin V.; Michelena, Hector M.; Daly, Richard C.; Kane, Garvan M.

In: Heart Lung and Circulation, 01.01.2019.

Research output: Contribution to journalArticle

Orde, SR, Chung, SY, Pulido, JN, Suri, RM, Stulak, JM, Oh, JK, Pislaru, SV, Michelena, HM, Daly, RC & Kane, GM 2019, 'Changes in Right Ventricle Function After Mitral Valve Repair Surgery', Heart Lung and Circulation. https://doi.org/10.1016/j.hlc.2019.06.724
Orde, Sam R. ; Chung, Sheng Ying ; Pulido, Juan N. ; Suri, Rakesh M. ; Stulak, John M. ; Oh, Jae Kuen ; Pislaru, Sorin V. ; Michelena, Hector M. ; Daly, Richard C. ; Kane, Garvan M. / Changes in Right Ventricle Function After Mitral Valve Repair Surgery. In: Heart Lung and Circulation. 2019.
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abstract = "Background: Right ventricular (RV) dysfunction can occur after cardiac surgery and persist for years. We assessed perioperative RV systolic function in patients undergoing mitral valve (MV) repair and further compared minimally invasive robotic-assisted mitral valve repair (MIMVr) vs standard ‘open’ MV repair (MVr). Speckle tracking (RV free wall strain [RVS]) was used as a sensitive echocardiography method to assess RV function. Methods: Retrospective analysis, over 3 years, of consecutive patients (n = 158) referred to Mayo Clinic (Rochester, MN, USA). Preoperative, pre-discharge and 1 year transthoracic echocardiograms were reviewed. A prospective pilot study was performed for sample size estimation. Primary outcome was RV free wall strain (RVS). Results: Right ventricular free wall strain declined after MV repair surgery (-22.6 ± 7{\%} vs -15 ± 6{\%}, p < 0.001). There were smaller reductions in RVS in MIMVr vs MVr group (-6.0 ± 9{\%} vs -10.3 ± 8{\%}, p < 0.01), which persisted after adjusting for baseline values (RVS treatment effect 1.5{\%}, p = 0.007). There was greater recovery in MIMVr vs MVr group at 1 year follow-up vs pre-surgery values (-3.4 ± 9{\%} vs -8.1 ± 8{\%} respectively, p < 0.001, RVS treatment effect 1.7{\%}, p = 0.001). Bypass time was higher in the MIMVr group (80 min ± 22 vs 40 min ± 20, p < 0.0001). The echo findings remained significant correcting for age, pulmonary pressures and change in ejection fraction. Conclusions: Right ventricular systolic dysfunction is common after MV repair surgery. Deterioration in RV contraction is less pronounced following MIMVr vs MVr and is associated with enhanced RV functional recovery at 1 year, albeit not to preoperative levels. This may potentially be associated with clinical functional improvement but further studies are warranted to investigate this.",
keywords = "Echocardiography, Mitral valve repair, Right ventricle, Speckle tracking, Strain",
author = "Orde, {Sam R.} and Chung, {Sheng Ying} and Pulido, {Juan N.} and Suri, {Rakesh M.} and Stulak, {John M.} and Oh, {Jae Kuen} and Pislaru, {Sorin V.} and Michelena, {Hector M.} and Daly, {Richard C.} and Kane, {Garvan M}",
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T1 - Changes in Right Ventricle Function After Mitral Valve Repair Surgery

AU - Orde, Sam R.

AU - Chung, Sheng Ying

AU - Pulido, Juan N.

AU - Suri, Rakesh M.

AU - Stulak, John M.

AU - Oh, Jae Kuen

AU - Pislaru, Sorin V.

AU - Michelena, Hector M.

AU - Daly, Richard C.

AU - Kane, Garvan M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Right ventricular (RV) dysfunction can occur after cardiac surgery and persist for years. We assessed perioperative RV systolic function in patients undergoing mitral valve (MV) repair and further compared minimally invasive robotic-assisted mitral valve repair (MIMVr) vs standard ‘open’ MV repair (MVr). Speckle tracking (RV free wall strain [RVS]) was used as a sensitive echocardiography method to assess RV function. Methods: Retrospective analysis, over 3 years, of consecutive patients (n = 158) referred to Mayo Clinic (Rochester, MN, USA). Preoperative, pre-discharge and 1 year transthoracic echocardiograms were reviewed. A prospective pilot study was performed for sample size estimation. Primary outcome was RV free wall strain (RVS). Results: Right ventricular free wall strain declined after MV repair surgery (-22.6 ± 7% vs -15 ± 6%, p < 0.001). There were smaller reductions in RVS in MIMVr vs MVr group (-6.0 ± 9% vs -10.3 ± 8%, p < 0.01), which persisted after adjusting for baseline values (RVS treatment effect 1.5%, p = 0.007). There was greater recovery in MIMVr vs MVr group at 1 year follow-up vs pre-surgery values (-3.4 ± 9% vs -8.1 ± 8% respectively, p < 0.001, RVS treatment effect 1.7%, p = 0.001). Bypass time was higher in the MIMVr group (80 min ± 22 vs 40 min ± 20, p < 0.0001). The echo findings remained significant correcting for age, pulmonary pressures and change in ejection fraction. Conclusions: Right ventricular systolic dysfunction is common after MV repair surgery. Deterioration in RV contraction is less pronounced following MIMVr vs MVr and is associated with enhanced RV functional recovery at 1 year, albeit not to preoperative levels. This may potentially be associated with clinical functional improvement but further studies are warranted to investigate this.

AB - Background: Right ventricular (RV) dysfunction can occur after cardiac surgery and persist for years. We assessed perioperative RV systolic function in patients undergoing mitral valve (MV) repair and further compared minimally invasive robotic-assisted mitral valve repair (MIMVr) vs standard ‘open’ MV repair (MVr). Speckle tracking (RV free wall strain [RVS]) was used as a sensitive echocardiography method to assess RV function. Methods: Retrospective analysis, over 3 years, of consecutive patients (n = 158) referred to Mayo Clinic (Rochester, MN, USA). Preoperative, pre-discharge and 1 year transthoracic echocardiograms were reviewed. A prospective pilot study was performed for sample size estimation. Primary outcome was RV free wall strain (RVS). Results: Right ventricular free wall strain declined after MV repair surgery (-22.6 ± 7% vs -15 ± 6%, p < 0.001). There were smaller reductions in RVS in MIMVr vs MVr group (-6.0 ± 9% vs -10.3 ± 8%, p < 0.01), which persisted after adjusting for baseline values (RVS treatment effect 1.5%, p = 0.007). There was greater recovery in MIMVr vs MVr group at 1 year follow-up vs pre-surgery values (-3.4 ± 9% vs -8.1 ± 8% respectively, p < 0.001, RVS treatment effect 1.7%, p = 0.001). Bypass time was higher in the MIMVr group (80 min ± 22 vs 40 min ± 20, p < 0.0001). The echo findings remained significant correcting for age, pulmonary pressures and change in ejection fraction. Conclusions: Right ventricular systolic dysfunction is common after MV repair surgery. Deterioration in RV contraction is less pronounced following MIMVr vs MVr and is associated with enhanced RV functional recovery at 1 year, albeit not to preoperative levels. This may potentially be associated with clinical functional improvement but further studies are warranted to investigate this.

KW - Echocardiography

KW - Mitral valve repair

KW - Right ventricle

KW - Speckle tracking

KW - Strain

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