The Role of Right Ventricular Function in Mitral Valve Surgery


  • Xiumei Sun
  • Jennifer Ellis
  • Louis Kanda
  • Paul J. Corso



Background: An impaired right ventricular function is associated with a poor survival rate in patients with heart failure. Few investigations have analyzed the prognostic value of right ventricular function on the outcomes of mitral valve (MV) surgery. The objectives of this study were to define the effect of right ventricular function on postoperative outcomes after MV repair (MVP) or replacement (MVR).

Methods: From September 2007 to February 2012, 335 consecutive patients underwent MVP or MVR at our institution. Preoperative transthoracic and transesophageal echocardiography (TEE) and postoperative TEE were used to define right ventricular function and MV performance. Preoperative right ventricular function was graded as normal to mild (grade 1-2) or as moderate to severe (grade 3-4). MV or tricuspid valve regurgitation was graded as non-trivial to mild (grade 0-2) or as moderate to severe (grade 3-4) preoperatively and postoperatively. Survival rate was evaluated at 1 year after surgery.

Results: Of the 334 patients in the study, 280 patients showed a normal to a mildly impaired right ventricular function preoperatively (group 1). Fifty-four patients presented with moderate to severe right ventricular dysfunction (group 2). Patients with a compromised right ventricular function were more likely to undergo MVR (28.6% versus 53.7%, P <.001). The mean pulmonary artery pressure was 23.6 mm Hg in group 1 and 34 mm Hg in group 2 (P <.001). The left atrial diameter was 4.6 cm in group 1 and 5.3 cm in group 2 (P <.001). The 2 groups were not different with respect to operative mortality, but the patients in group 2 experienced more transfusion of blood products (588.4 mL versus 1180.6 mL, P <.001), longer intensive care unit stays (83.9 versus 149.6 hours, P <.001), and hospital stays (8.9 versus 12.8 days, P = .005). The rate of postoperative MV regurgitation was significantly higher in group 2 (1.8 versus 14.8%, P <.001). The overall 1-year survival rate was 92.5% in group 1 and 94.5% in group 2 (P = .59).

Conclusions: This study has shown that a dysfunctional preoperative right ventricular function uses more resources and is associated with postoperative MV regurgitation, but it is not associated short- and mid-term mortality after MV surgery.


Abramson SV, Burke JF, Kelly JJ Jr, et al. 1992. Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy. Ann Intern Med 116:888-95.nBolft J, Zickmann B, Ballesteros M, Dapper F, Hempelmann G. 1992. Right ventricular function in patients with aortic stenosis undergoing aortic valve replacement. J Cardiothorac Vasc Anesth 6:287-91.nBorer JS, Hochreiter C, Rosen S. 1991. Right ventricular function in severe non-ischemic mitral insufficiency. Eur Heart J 12(suppl B):22-5.nDe Groote P, Millaire A, Foucher-Hossein C, et al. 1998. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 32:948-54.nGhio S, Gavazzi A, Campana C, et al. 2001. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 37:183-8.nKinch JW, Ryan TJ. 1994. Right ventricular infarction. N Engl J Med 330:1211-7.nLansman SL, Cohen M, Galla JD, et al. 1993. Coronary artery bypass with ejection fraction of 0.20 or less using centigrade cardioplegia: long-term follow-up. Ann Thorac Surg 56:480-6.nMishra M, Swaminathan M, Malhotra R, Mishra A, Trehan N. 1998. Evaluation of right ventricular function during CABG: transesophageal echocardiographic assessment of hepatic venous flow versus conventional right ventricular performance indices. Echocardiography 15:51-8.nMorrison D, Golman S, Wright AL, et al. 1983. The effect of pulmonary hypertension on systolic function of the right ventricle. Chest 84:250-7.nMorrison DA, Lancaster L, Henry R, Goldman S. 1985. Right ventricular function at rest and during exercise in aortic and mitral valve disease. J Am Coll Cardiol 5:21-8.nOnorato F, Santarpino G, Marturano D, et al. 2009. Successful surgical treatment of chronic ischemic mitral regurgitation achieves left ventricular reverse remodeling but does not affect right ventricular function. J Thorac Cardiovasc Surg 138:341-51.nPinzani A, de Gevigney G, Pinzani V, Ninet J, Milon H, Delahayer JP. 1993. Pre- and postoperative right cardiac insufficiency in patients with mitral or mitral-aortic valve diseases. Arch Mal Coeur Vaiss 86:27-34.nReichert CLA, Visser CA, Van den Brink RBA, et al. 1992. Prognostic value of biventricular function in hypotensive patients after cardiac surgery as assessed by transesophageal echocardiography. J Cardiothorac Vasc Anesth 6:429-32.nSakata K, Yoshino H, Kurihara H, et al. 2000. Prognostic significant of persistent right ventricular dysfunction as assessed by radionuclide angiocardiography in patients with inferior wall acute myocardial infarction. Am J Cardiol 85:939-44.nWencker D, Borer JS, Hockreiter C, et al. 2000. Preoperative predictors of late postoperative outcome among patients with nonischemic mitral regurgitation with ‘high risk’ descriptors and comparison with unoperated patients. Cardiology 93:37-42.nWroblewski E, James F, Spann JF, Bove AA. 1981. Right ventricular performance in mitral stenosis. Am J Cardiol 47:51-5.nZoghbi WA, Enriquez-Sarano M, Foster E, et al. 2003. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777-802.n



How to Cite

Sun, X., Ellis, J., Kanda, L., & Corso, P. J. (2013). The Role of Right Ventricular Function in Mitral Valve Surgery. The Heart Surgery Forum, 16(3), E170-E176.




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