429 Right ventricular longitudinal and radial fiber contractility in patients undergoing mitral valve surgery: a PREPARE-MVR substudy

Abstract

Abstract Severe mitral regurgitation results in significant hemodynamic demands of not only the left, but the right ventricle (RV) as well. Increased pulmonary pressures and consequential pressure overload of the RV induces complex remodeling, which can be partially restored by mitral valve repair/replacement (MVR). MVR is associated with marked changes of RV deformation, however, the clinical significance of these changes is not well estabilished. The PREPARE-MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) aims to determine parameters, which may predict the perioperative risk of acute RV failure. In this current substudy, our aim was to determine the changes of RV global, longitudinal and radial fiber contractility before and following MVR. Our study group consisted of 27 MVR patients (mean age: 64 ± 12 years, m/f: 19/8). Transthoracic 3D echocardiography was performed before the operation and following intensive care unit discharge. 3D beutel model of the RV was created and RV end-diastolic volume index (EDVi) among with RV ejection fraction (RVEF) were calculated using commercially available software. For in-depth analysis of RV mechanics, we have decomposed the motion of the RV using our custom software (ReVISION) to determine longitudinal (LEF) and radial ejection fraction (REF). Right heart catheterization was also performed before MVR and 24 hours after MVR as well to measure pulmonary arterial mean systolic pressure (mPAP), pulmonary arterial wedge pressure (PAWP) and RV stroke work index (RVSWi). Using the aforementioned parameters, we have calculated RV longitudinal (longRVSWi) and RV radial stroke work index (radRVSWi), which represent RV longitudinal and radial fiber contractility. RV morphology did not change significantly according to RVEDVi (preop vs. postop: 71 ± 17 vs. 72 ± 20 mL/m², p = NS). RVEF slightly decreased after MVR (50 ± 6 vs. 48 ± 7 %, p < 0.05), however, RV motion pattern markedly changed. Postoperative LEF was significantly lower compared to preoperative values (25 ± 6 vs. 16 ± 6%, p < 0.0001), among with an increase in REF (21 ± 7 vs. 27 ± 7%, p < 0.01). As expected, mPAP and PAWP decreased in response to MVR (mPAP: 30 ± 10 vs. 25 ± 7 mmHg; PAWP: 19 ± 7 vs. 13 ± 3 mmHg, both p < 0.01). Global RV contractility decreased after surgery (RVSWi: 603 ± 355 vs. 474 ± 251 mmHg*mL/m², p < 0.05). While RV longitudinal contractility also significantly reduced (longRVSWi: 289 ± 179 vs. 166 ± 122 mmHg*mL/m², p < 0.001), radial contractility was maintained following MVR (radRVSWi: 240 ± 141 vs. 261 ± 144 mmHg*mL/m², p = NS). MVR is associated with marked changes of RV function and hemodynamics. RV longitudinal and radial contractility have distinct response to surgery, which may be important in postoperative patient management. The PREPARE-MVR study aims to examine the role of preoperative RV mechanics in clinical outcome.