Right ventricular assessment can improve prognostic value of Euroscore II

Michele Di Mauro, Roberto Scrofani, Carlo Antona, Francesca Nicolò, Giangiuseppe Cappabianca, Cesare Beghi, Giuseppe Santarpino, Renato Gregorini, Luca Di Marco, Davide Pacini, Antonio Salsano, Francesco Santini, Luca Weltert, Ruggero De Paulis, Marco Pano, Salvatore Zaccaria, Alessandro D'Alfonso, Marco Di Eusanio, Francesco Massi, Michele PortogheseErik Cura Stura, Mauro Rinaldi, Vito Margari, Massimiliano Foschi, Alessandro Parolari, Domenico Paparella

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery.

METHODS: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC <35%, TAPSE <17 mm, and TDI S' <9.5 mm RESULTS: Among the entire cohort, 624 (70%) showed normal RV, 92 (10%) isolated RV dilatation, 154 (17%) isolated RV dysfunction, and 25 (3%) both RV dilatation and dysfunction. Non-surviving patients showed a significantly higher rate of RV alteration at multivariable analysis, RV status was found to be an independent predictor for higher in-hospital mortality beside Euroscore II.

CONCLUSIONS: This prospective multicenter observation study shows the importance to assess RV preoperatively and to include both RV function and dimension in a risk score model such as Euroscore II to implement its predictivity, since PH cannot always mirror the status of the right ventricle.

Original languageEnglish
Pages (from-to)1548-1555
Number of pages8
JournalJournal of Cardiac Surgery
Volume35
Issue number7
DOIs
Publication statusPublished - Jul 2020

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiac Surgical Procedures/mortality
  • Dilatation, Pathologic
  • Female
  • Heart Ventricles/pathology
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care/methods
  • Preoperative Period
  • Prognosis
  • Prospective Studies
  • Research Design
  • Risk
  • Ventricular Dysfunction, Right
  • Ventricular Function, Right
  • Young Adult

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