From the Guidelines
Postoperative right ventricular (RV) dysfunction following mitral valve and tricuspid valve repair surgery is commonly caused by pre-existing pulmonary hypertension, ischemia-reperfusion injury, and prolonged cardiopulmonary bypass time 1.
Common Causes of RV Dysfunction
- Pulmonary hypertension: Pre-existing elevated pulmonary pressures can lead to RV dysfunction, particularly if left untreated or undertreated 1.
- Ischemia-reperfusion injury: The use of cardioplegic agents and the ischemic period during surgery can cause damage to the RV, leading to dysfunction 1.
- Prolonged cardiopulmonary bypass time: Longer bypass times can increase the risk of RV dysfunction due to increased inflammation and oxidative stress 1.
- Fluid overload: Postoperative fluid overload, often requiring diuretic therapy, can exacerbate RV dysfunction, particularly in patients with pre-existing tricuspid regurgitation or pulmonary hypertension 1.
- Mechanical ventilation: High positive end-expiratory pressure (PEEP) levels can also contribute to RV dysfunction by increasing RV afterload 1.
Additional Factors
- Tricuspid valve repair: The severity of preoperative tricuspid regurgitation and RV dysfunction can contribute to residual postoperative tricuspid regurgitation 1.
- Tricuspid annular dilatation: Severe tricuspid annular dilatation can predict residual tricuspid regurgitation after tricuspid valve annuloplasty 1. The management of postoperative RV dysfunction requires careful consideration of these factors and individualized treatment strategies to optimize patient outcomes 1.
From the Research
Common Causes of Postoperative Right Ventricular Dysfunction
The common causes of postoperative right ventricular (RV) dysfunction following mitral valve and tricuspid valve repair surgery include:
- Pulmonary hypertension 2, 3
- Tricuspid regurgitation 4, 3
- Right ventricular systolic dysfunction 5, 2
- Elevated pulmonary artery systolic pressure (PASP) 2
Factors Influencing Right Ventricular Function
Several factors can influence right ventricular function after mitral valve repair surgery, including:
- Surgical strategy, with minimally invasive robotic-assisted mitral valve repair (MIMVr) potentially leading to less deterioration in RV function compared to standard 'open' MV repair (MVr) 5
- Bypass time, with longer bypass times potentially leading to worse RV function 5
- Preoperative RV function, with patients having poorer preoperative RV function being more likely to experience postoperative RV dysfunction 2
Impact of Tricuspid Valve Repair
Tricuspid valve repair can improve in-hospital outcomes in patients with mild-to-moderate tricuspid regurgitation undergoing mitral valve repair, by maintaining tricuspid valve function and avoiding right ventricular dysfunction 4
Prognostic Value of Pulmonary Hypertension, Right Ventricular Function, and Tricuspid Regurgitation
Pulmonary hypertension, right ventricular dysfunction, and tricuspid regurgitation are all significant predictors of mortality after transcatheter mitral valve repair, highlighting the importance of careful assessment of these parameters before clinical decision-making 3