Cardiology - Original Articles
Early Access
Right ventricular function as a predictor of morbidity and mortality in post-heart valve surgery
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 December 2025
194
Views
89
Downloads
Authors
Valvular heart disease (VHD) remains a significant global health concern, with mortality rates ranging from 1% to 15%. In Indonesia, the most prevalent form of VHD is rheumatic heart disease, which is associated with a hospital mortality rate of 6.5% following valve surgery. Previous studies have shown that, post-surgery, morbidity rates remain high: 30.8% of patients experience prolonged intensive care unit stays (>96 hours), 30.67% require extended mechanical ventilation (>24 hours), and 52% need prolonged use of inotropic agents (≥14 days). Right ventricular (RV) dysfunction is closely associated with these three morbidity parameters, as well as with 30-day postoperative mortality. However, limited research in Indonesia has explored the most effective parameters for evaluating RV function as a predictor of postoperative morbidity and mortality following heart valve surgery. This prospective cohort study was conducted at the Department of Cardiology and Vascular Medicine, Universitas Indonesia, and the National Cardiovascular Center Harapan Kita (NCCHK) from October 2023 to July 2024. During this period, 174 patients with VHD who underwent surgical valve replacement were enrolled. After applying exclusion criteria, 26 patients were excluded, resulting in a final study population of 148 patients. All participants underwent preoperative echocardiographic assessment of RV function, performed by two operators within 1 week prior to surgery. Among the 148 subjects, females comprised the majority (60.1%). Atrial fibrillation (AF) was the most common comorbidity, affecting 62.8% of the cohort. The most frequent morbidity outcome was prolonged mechanical ventilation, observed in 27.7% of cases. Of the total mortality events, 70% were cardiac-related, while the remaining 30% were due to non-cardiac causes. Multivariate analysis revealed that a preoperative S′<10 cm/s was significantly associated with cardiac-related mortality [odds ratio (OR) 3.46; 95% confidence interval (CI) 1.01-11.87; p=0.049]. Additionally, a preoperative S′<11 cm/s was significantly associated with overall clinical outcomes, including both morbidity and all-cause mortality (OR 3.08; 95% CI 1.43-6.65; p=0.004). In conclusion, S′, an echocardiographic parameter reflecting RV function, demonstrates potential as a predictive marker for postoperative morbidity and mortality in patients undergoing heart valve surgery.
Downloads
Download data is not yet available.
Citations
Casalino R, Paula LJC de, Martins EB, Tarasoutchi F. Valvular heart disease and risk score systems in clinical practice. EMJ Cardiol 2016;4:103-6. DOI: https://doi.org/10.33590/emjcardiol/10313053
Kardiologi Indonesia J. Penyakit Jantung Katup di Indonesia: masalah yang hampir terlupakan. IJC 2012;33:205-8. [Article in Indonesian]. DOI: https://doi.org/10.30701/ijc.v33i4.20
Ibrahim KS, Kheirallah KA, Mayyas FA, e al. Predictors of short-term mortality after rheumatic heart valve surgery: a single-center retrospective study. Ann Med Surg 2021;62:395-401. DOI: https://doi.org/10.1016/j.amsu.2021.01.077
Agarwal S, Garg A, Parashar A, et al. In-hospital mortality and stroke after surgical aortic valve replacement: a nationwide perspective. J Thorac Cardiovasc Surg 2015;150:571-8.e8. DOI: https://doi.org/10.1016/j.jtcvs.2015.05.068
Glaser N, Jackson V, Eriksson P, et al. Relative survival after aortic valve surgery in patients with bicuspid aortic valves. Heart 2021;107:1167-72. DOI: https://doi.org/10.1136/heartjnl-2020-318733
Ternacle J, Berry M, Cognet T, et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr 2013;26:721-6. DOI: https://doi.org/10.1016/j.echo.2013.03.021
Soesanto AM, Husink A, Ariyanti N, et al. A simple scoring system for predicting in-hospital mortality after heart valve surgery in a developing country. IJC 2021;42:126-36. DOI: https://doi.org/10.30701/ijc.1174
Azarfarin R, Ashouri N, Totonchi Z, et al. Factors influencing prolonged ICU stay after open heart surgery. Res Cardiovasc Med 2014;3:e20159. DOI: https://doi.org/10.5812/cardiovascmed.20159
Schenk S, McCarthy PM, Blackstone EH, et al. Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome. J Thorac Cardiovasc Surg 2006;131:447-54. DOI: https://doi.org/10.1016/j.jtcvs.2005.09.031
The Society of Thoracic Surgeons. Performance measure descriptions. Available from: https://www.sts.org/quality-safety/performance-measures/descriptions.
Levy D, Laghlam D, Estagnasie P, et al. Post-operative right ventricular failure after cardiac surgery: a cohort study. Front Cardiovasc Med 2021;8:667328. DOI: https://doi.org/10.3389/fcvm.2021.667328
Towheed A, Sabbagh E, Gupta R, et al. Right ventricular dysfunction and short-term outcomes following left-sided valvular surgery: an echocardiographic study. J Am Heart Assoc 2021;10:e016283. DOI: https://doi.org/10.1161/JAHA.120.016283
Torres DJR, Quintero LT, Rodríguez DS, et al. Behavior of echocardiographic parameters of right ventricular function after tricuspid surgery. Sci Rep 2022;12:19447. DOI: https://doi.org/10.1038/s41598-022-24048-1
Galloo X, Meucci MC, Stassen J, et al. Right ventricular reverse remodeling after tricuspid valve surgery for significant tricuspid regurgitation. Struct Heart 2022;7:100101. DOI: https://doi.org/10.1016/j.shj.2022.100101
de Hond AAH, Steyerberg EW, van Calster B. Interpreting area under the receiver operating characteristic curve. Lancet Digit Health 2022;4:e853-5. DOI: https://doi.org/10.1016/S2589-7500(22)00188-1
Aluru JS, Barsouk A, Saginala K, et al. Valvular heart disease epidemiology. Med Sci 2022;10:32. DOI: https://doi.org/10.3390/medsci10020032
Baan J, Jim EL, Joseph VF. Gambaran kelainan katup jantung pada pasien penyakit jantung rematik dan pasien penyakit jantung bawaan pada orang dewasa di rsup prof kandou. Jurnal Kedokteran Klinik 2016;1:109-15.
Cheng YY, Brieger D, Bannon P, et al. Outcomes following triple cardiac valve surgery over 17-years: a multicentre population-linkage study. Heart Lung Circ 2023;32:269-77. DOI: https://doi.org/10.1016/j.hlc.2022.09.018
van der Does LJME, Lanters EAH, Teuwen CP, et al. The effects of valvular heart disease on atrial conduction during sinus rhythm. J Cardiovasc Transl Res 2020;13:632-9. DOI: https://doi.org/10.1007/s12265-019-09936-8
Lee E, Choi EK, Han KD, et al. Mortality and causes of death in patients with atrial fibrillation: a nationwide population-based study. PLoS One 2018;13:e0209687. DOI: https://doi.org/10.1371/journal.pone.0209687
Collins N, Sugito S, Davies A, et al. Prevalence and survival associated with pulmonary hypertension after mitral valve replacement: national echocardiography database of Australia study. Pulm Circ 2022;12:e12140. DOI: https://doi.org/10.1002/pul2.12140
Lashin H, Olusanya O, Bhattacharyya S. Right ventricular function is associated with 28-day mortality in myocardial infarction complicated by cardiogenic shock: A retrospective observational study. J Intensive Care Soc 2022;23:439-46. DOI: https://doi.org/10.1177/17511437211037927
Oketona OA, Balogun MO, Akintomide AO, et al. Right ventricular systolic function in hypertensive heart failure. Vasc Health Risk Manag 2017;13:353-60. DOI: https://doi.org/10.2147/VHRM.S142429
Mandoli GE, Cameli M, Novo G, et al. Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography. Heart Fail Rev 2019;24:625-35. DOI: https://doi.org/10.1007/s10741-019-09785-2
Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713. DOI: https://doi.org/10.1016/j.echo.2010.05.010
Zhang Y, Sun W, Wu C, et al. Prognostic value of right ventricular ejection fraction assessed by 3D echocardiography in COVID-19 patients. Front Cardiovasc Med 2021;8:641088. DOI: https://doi.org/10.3389/fcvm.2021.641088
Tse YK, Li HL, Yu SY, et al. Prognostic value of right ventricular remodelling in patients undergoing concomitant aortic and mitral valve surgery. Eur Heart J Cardiovasc Imaging 2023;24:653-63. DOI: https://doi.org/10.1093/ehjci/jeac162
Grønlykke L, Ravn HB, Gustafsson F, et al. Right ventricular dysfunction after cardiac surgery – diagnostic options. Scand Cardiovasc J 2017;51:114-21. DOI: https://doi.org/10.1080/14017431.2016.1264621
King A, Thambyrajah J, Leng E, Stewart MJ. Global longitudinal strain: a useful everyday measurement? Echo Res Pract 2016;3:85-93. DOI: https://doi.org/10.1530/ERP-16-0022
Erriyanti S, Soesanto AM, Sakidjan I, et al. The the impact of tricuspid annular plane systolic excursion (TAPSE) after mitral valve surgery on long term mortality. IJC 2022;43:1-8. DOI: https://doi.org/10.30701/ijc.1196
Zanobini M, Saccocci M, Tamborini G, et al. Postoperative echocardiographic reduction of right ventricular function: is pericardial opening modality the main culprit? Biomed Res Int 2017;2017:4808757. DOI: https://doi.org/10.1155/2017/4808757
Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. Eur J Echocardiogr 2009;10:630-4. DOI: https://doi.org/10.1093/ejechocard/jep015
Li Q, Zhang M. Echocardiography assessment of right ventricular-pulmonary artery coupling: validation of surrogates and clinical utilities. Int J Cardiol 2024;394:131358. DOI: https://doi.org/10.1016/j.ijcard.2023.131358
Ma Q, Ding C, Wei W, et al. The value of right ventricular pulmonary artery coupling in determining the prognosis of patients with sepsis. Sci Rep 2024;14:15283. DOI: https://doi.org/10.1038/s41598-024-65738-2
Anavekar NS, Gerson D, Skali H, et al. Two-dimensional assessment of right ventricular function: an echocardiographic-MRI correlative study. Echocardiography 2007;24:452-6. DOI: https://doi.org/10.1111/j.1540-8175.2007.00424.x
Dutta T, Aronow WS. Echocardiographic evaluation of the right ventricle: clinical implications. Clin Cardiol 2017;40:542-8. DOI: https://doi.org/10.1002/clc.22694
Nagata Y, Kado Y, Onoue T, et al. Impact of image quality on reliability of the measurements of left ventricular systolic function and global longitudinal strain in 2D echocardiography. Echo Res Pract 2018;5:27-39. DOI: https://doi.org/10.1530/ERP-17-0047
Schmidt AG, Gerst M, Zhai J, et al. Evaluation of left ventricular diastolic function from spectral and color M-mode doppler in genetically altered mice. J Am Soc Echocardiogr 2002;15:1065-73. DOI: https://doi.org/10.1067/mje.2002.121863
El-Fiky MM, El-Sayegh T, El-Beishry AS, et al. Limited right anterolateral thoracotomy for mitral valve surgery. Eur J Cardiothorac Surg 2000;17:710-3. DOI: https://doi.org/10.1016/S1010-7940(00)00429-2
Tokodi M, Németh E, Lakatos BK, et al. Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post-operative dysfunction? ESC Heart Fail 2020;7:1246-56. DOI: https://doi.org/10.1002/ehf2.12682
Nagata Y, Wu VCC, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ Cardiovasc Imaging 2017;10:e005384. DOI: https://doi.org/10.1161/CIRCIMAGING.116.005384
Ethics Approval
The study protocol was approved by the Ethical Review Committee of National Cardiovascular Center Harapan Kita, Universitas Indonesia, on November 8th, 2023 (Protocol no. DP/04.03/KEP210/EC094/202).How to Cite
“Right Ventricular Function As a Predictor of Morbidity and Mortality in Post-Heart Valve Surgery”. 2025. Monaldi Archives for Chest Disease, December. https://doi.org/10.4081/monaldi.2025.3447.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.