Right ventricular to pulmonary arterial coupling as a predictor of survival in patients undergoing mitral valve surgery for mitral regurgitation

Omar Chehab; Edouard Long; Vitaly Androshchuk; Harminder Gill; Vassilios Avlonitis; Paolo Bosco; Gianluca Lucchese; Tiffany Patterson; Simon Redwood; Ronak Rajani

doi:10.1093/ejcts/ezae421

Right ventricular to pulmonary arterial coupling as a predictor of survival in patients undergoing mitral valve surgery for mitral regurgitation

Eur J Cardiothorac Surg. 2024 Nov 28:ezae421. doi: 10.1093/ejcts/ezae421. Online ahead of print.

Affiliations

¹ Department of Cardiology, St Thomas' Hospital, London, UK.
² GKT School of Medical Education, King's College London, London, UK.
³ Department of Cardiac Surgery, St Thomas' Hospital, London, UK.

PMID: 39607781
DOI: 10.1093/ejcts/ezae421

Abstract

Objectives: Right ventricular-to-pulmonary artery (RV-PA) coupling has been associated with outcomes in mitral regurgitation (MR) treated by transcatheter approaches. We evaluated RV-PA coupling as a predictor of survival and post-operative length of hospital stay (LOS) in patients with mitral regurgitation undergoing mitral valve (MV) surgery.

Methods: In this retrospective analysis (median follow-up: 5.8 years), RV-PA coupling was quantified as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) using transthoracic echocardiography (TTE). Receiver operating characteristic (ROC) curve analysis was used to determine the optimum cut-point of TAPSE/PASP to predict all-cause mortality and the study population was dichotomised according to this value. The primary end-point was all-cause mortality. A secondary end-point of LOS was also assessed.

Results: Out of 142 patients (median age: 67, female: 49%), 35 showed impaired coupling at baseline (TAPSE/PASP ≤0.35). Patients with TAPSE/PASP ≤0.35 had higher absolute mortality (37% vs 8%, p < 0.001) and longer LOS (7 days vs 9 days, p = 0.04). Kaplan-Meier analysis revealed lower survival in patients with TAPSE/PASP ≤0.35 (log-rank: p < 0.0001). In multivariable Cox regression, TAPSE/PASP ≤0.35 was the most significant predictor of all-cause mortality (HR: 3.69, 95% CI: 1.31-10.1, p = 0.011), alongside chronic obstructive pulmonary disease and estimated glomerular filtration rate. TAPSE/PASP ≤0.35 was associated with significantly increased LOS (β: 4.6, 95% CI: 0.66-8.5, p = 0.022) alongside left ventricular ejection fraction, MV replacement, and urgent operation.

Conclusions: In MR patients undergoing MV surgery, TAPSE/PASP ≤0.35 is associated with increased mortality and LOS. Further validation is indicated in larger, prospective cohorts.

Keywords: Cardiac surgery; Mitral regurgitation; Mitral surgery; Right ventricle; Right ventricular pulmonary artery coupling; TAPSE/PASP.