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.

Right ventricular assessment can improve prognostic value of Euroscore II / M. Di Mauro, R. Scrofani, C. Antona, F. Nicolo, G. Cappabianca, C. Beghi, G. Santarpino, R. Gregorini, L. Di Marco, D. Pacini, A. Salsano, F. Santini, L. Weltert, R. De Paulis, M. Pano, S. Zaccaria, A. D'Alfonso, M. Di Eusanio, F. Massi, M. Portoghese, E.C. Stura, M. Rinaldi, V. Margari, M. Foschi, A. Parolari, D. Paparella. - In: JOURNAL OF CARDIAC SURGERY. - ISSN 0886-0440. - 35:7(2020 Jul), pp. 1548-1555. [10.1111/jocs.14672]

Right ventricular assessment can improve prognostic value of Euroscore II

R. Scrofani;C. Antona;L. Di Marco;F. Massi;M. Foschi;A. Parolari
Penultimo
;
2020-07

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.
Euroscore II; right ventricle; right ventricular dilatation; right ventricular dysfunction; Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Dilatation, Pathologic; Female; Heart Ventricles; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Preoperative Period; Prognosis; Prospective Studies; Risk; Ventricular Dysfunction, Right; Young Adult; Research Design; Ventricular Function, Right
Settore MED/23 - Chirurgia Cardiaca
giu-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/813927
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