Functional changes of the right ventricle and right atrium after surgery for primary mitral regurgitation

Abstract Background Tricuspid annular plane systolic excursion (TAPSE) is a widely used parameter to assess right ventricular (RV) function in patients with primary mitral regurgitation (PMR), but is considered unreliable after cardiac surgery. However, little is known about the post-operative changes in other RV functional parameters, or in right atrial (RA) size and function. Purpose To assess the changes in RV and RA after PMR surgery, and to evaluate their association with outcome. Methods Patients who underwent surgery for PMR and had echocardiograms available before surgery and immediately post-operative (pre-discharge) were included. TAPSE, fractional area change (FAC), RV longitudinal (RVLS) and free-wall (RVFWLS) strains, RA volume index (RAVI) and RA reservoir strain (RASr) were measured. A subgroup analysis was performed in patients with a longer-term follow-up echocardiography available. Study endpoint was all cause mortality. Results A total of 702 patients were included, of which 351 (50%) received concomitant tricuspid valve repair (TVP). Compared to baseline, TAPSE (23.2 vs 10.7 mm), RVLS (-19.9 vs -15.4%) and RVFWLS (-23.9 vs -16.8%) significantly decreased immediately postoperative (p