Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1161-1167. doi: 10.1093/ejcts/ezx201.
Surgical left ventricular (LV) restoration (SVR) induces changes in LV systolic and diastolic function that may affect postoperative right ventricular (RV) function. This study aimed to evaluate the long-term effect of SVR on RV function, with specific focus on determinants and prognostic implications of RV dysfunction.
Eighty-six patients (age 60 ± 10 years, 73% male) with clinical and echocardiographic follow-up 2 years after SVR were included. RV dysfunction was defined as RV fractional area change <35%. The association between RV dysfunction at follow-up and clinical and echocardiographic characteristics and outcome was investigated.
RV dysfunction at follow-up was present in 40% of patients and was associated with worse preoperative RV fractional area change (39 ± 9 vs 46 ± 7%, P < 0.01), pulmonary hypertension (18 vs 4%, P = 0.03) and higher follow-up LV filling pressures (E/E' ratio 23 ± 8 vs 15 ± 8, P = 0.02). At follow-up, patients with RV dysfunction were more frequently in New York Heart Association Class III or IV (30 vs 12%, P = 0.04) and 5-year mortality, heart transplantation and LV assist device implantation rate was increased (49 vs 17%, P < 0.01) as compared to patients with normal RV function.
RV dysfunction after SVR was observed in 40% of patients and was associated with preoperative RV dysfunction, presence of pulmonary hypertension and an increase in LV filling pressures at follow-up. Patients with RV dysfunction after SVR had worse clinical functioning and outcome as compared to patients with normal RV function.
左心室（LV）外科修复（SVR）可引起 LV 收缩和舒张功能的变化，这可能影响术后右心室（RV）功能。本研究旨在评估 SVR 对 RV 功能的长期影响，特别关注 RV 功能障碍的决定因素和预后意义。
纳入 86 例（年龄 60±10 岁，73%为男性）患者，在 SVR 后 2 年进行临床和超声心动图随访。RV 功能障碍定义为 RV 节段面积变化率<35%。研究调查了随访时 RV 功能障碍与临床和超声心动图特征及结局之间的关系。
随访时 RV 功能障碍的发生率为 40%，与术前 RV 节段面积变化率较差（39±9%比 46±7%，P<0.01）、肺动脉高压（18%比 4%，P=0.03）和较高的随访 LV 充盈压（E/E' 比值 23±8 比 15±8，P=0.02）相关。随访时，RV 功能障碍患者更常处于纽约心脏协会（NYHA）心功能 III 或 IV 级（30%比 12%，P=0.04），5 年死亡率、心脏移植和 LV 辅助装置植入率更高（49%比 17%，P<0.01）。
SVR 后 RV 功能障碍在 40%的患者中观察到，与术前 RV 功能障碍、肺动脉高压存在以及随访时 LV 充盈压增加相关。与 RV 功能正常的患者相比，SVR 后 RV 功能障碍患者的临床功能和结局更差。
