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Pre-operative right ventricular echocardiographic parameters associated with short-term outcomes and long-term mortality after CABG

Echo Research & Practice volume 5, pages 155–166 (2018)Cite this article

Abstract

Background: This analysis aims to assess the prognostic value of pre-operative right ventricular echocardiographic parameters in predicting short-term adverse outcomes and long-term mortality after coronary artery bypass graft (CABG).

Methods: Study design: Observational retrospective cohort. Pre-operative echocardiographic data, perioperative adverse outcomes (POAO) and long-term mortality were retrospectively analyzed in 491 patients who underwent isolated CABG at a single academic center between 2006 and 2014.

Results: Average age of enrolled subjects was 66 ± 11.5 years with majority being male (69%). 227/491 patients had 30 days POAO (46%); most common being post-operative atrial fibrillation (27.3%) followed by prolonged ventilation duration (12.7%). On multivariate analysis, left atrial volume index ≥ 42 mL/m2 (LAVI) (OR (95% CI): 1.98 (1.03-3.82), P = 0.04), mitral E/A > 2 (1.97 (1.02-3.78), P = 0.04), right atrial size >18 cm2 (1.86 (1.14-3.05), P = 0.01), tricuspid annular plane systolic excursion (TAPSE) <16 mm (1.8 (1.03-3.17), P = 0.04), right ventricular systolic pressure (RVSP) =36 mmHg (pulmonary hypertension) (1.6 (1.03-2.38), P = 0.04) and right ventricle myocardial performance index (RVMPI) > 0.55 (1.58 (1.01-2.46), P = 0.04) were found to be associated with increased 30-day POAO. On 3.5-year follow-up, cumulative survival was decreased in patients with myocardial performance index (MPI) ≥ 0.55 (log rank: 4.5, P = 0.034) and in patients with mitral valve E/e′ ≥ 14 (log rank: 4.9, P = 0.026).

Conclusion: Pre-operative right ventricle dysfunction (RVD) is associated with increased perioperative complications. Furthermore, pre-operative RVD and increased left atrial pressures are associated with long-term mortality post CABG.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA

    Mohammed Andaleeb Chowdhury MD MRCP, Jered M. Cook MD, George V. Moukarbel MD, Christopher J. Cooper MD & Samer J. Khouri MD

  2. University of Toledo Medical Center, Toledo, Ohio, USA

    Sana Ashtiani MD

  3. Division of Cardiothoracic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA

    Thomas A. Schwann MD & Mark R. Bonnell MD

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  1. Mohammed Andaleeb Chowdhury MD MRCP
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Chowdhury, M.A., Cook, J.M., Moukarbel, G.V. et al. Pre-operative right ventricular echocardiographic parameters associated with short-term outcomes and long-term mortality after CABG. Echo Res Pract 5, 155–166 (2018). https://doi.org/10.1530/ERP-18-0041

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Echo Research & Practice

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