Right ventricular function as a predictor of morbidity and mortality in post-heart valve surgery

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.