Right ventricle to pulmonary artery coupling as a predictor of perioperative outcome in patients with secondary mitral valve insufficiency

Background: The aim of the study was to assess some parameters of right ventricle (RV) function aspredictors of short-term mortality in patients with severe secondary mitral regurgitation (SMR) aftermitral valve surgery.Methods: We conducted a retrospective analysis of 112 consecutive patients with severe SMR whohad undergone mitral valve repair or replacement with or without concomitant coronary artery bypasssurgery. We assessed RV to pulmonary artery coupling by calculating the ratio of tricuspid annularplane systolic excursion (TAPSE) to non-invasively estimated RV systolic pressure (RVSP). The studyendpoint was 30 days post-procedural mortality.Results: Overall, the 30-day mortality was 6%. TAPSE/RVSP ratio < 0.42 mm/mmHg was a significantpredictor of mortality and remained so after adjusting for age and sex. The Kaplan-Meier survivalanalysis showed that patients with RVSP > 55 mmHg and those with TAPSE/RVSP ratio < 0.42 mm/mmHg had a lower survival probability.Conclusions: TAPSE/RVSP < 0.42 mm/mmHg is a strong predictor of short-term mortality in patientswith SMR when considered for valve surgery

Impact of the mechanism of mitral regurgitation on clinical outcomes in patients after mitral valve surgery

Background: Mitral regurgitation (MR) is the second most frequent indication for valve surgery. There are few studies addressing mitral valve (MV) surgery in the context of etiology of MR. Aims: We aimed to compare postoperative outcomes in the context of the etiological mechanism of MR in patients after MV surgery. Methods: The study group included 337 consecutive patients with severe MR. Preoperative comorbidities, postoperative clinical course, and predictors of in‑hospital mortality were assessed. Results: Primary etiology of MR was observed in 72% of patients, and of secondary, in 28% (P < 0.001). Among the primary MR group, the most common etiological factor was fibroelastic deficiency (79%), followed by Barlow disease (16%) and rheumatic disease (5%) (P < 0.001). Secondary MR was seen in ischemic heart disease (67%) and dilated cardiomyopathy (33%) (P < 0.001). The incidence of death and complications following surgery did not differ between the groups. Univariate analysis revealed that higher risk of death was associated with older age, severe heart failure symptoms, impaired left ventricular ejection fraction, previous percutaneous coronary interventions, cardiopulmonary bypass time, low cardiac output syndrome, and wound infections (P = 0.004, P < 0.001, P = 0.005, P = 0.009, P = 0.002, P = 0.006, and P = 0.03, respectively). Also MV replacement with concomitant other valve surgery increased the risk of mortality (P = 0.049). Conclusions: This study indicates that the clinical outcomes and in‑hospital mortality in patients with severe MR correlate with the type of procedure and concomitant perioperative comorbidities rather than the etiological mechanism of MR itself