106RIGHT VENTRICULAR FUNCTION AFTER SURGICAL VENTRICULAR RECONSTRUCTION IN HEART FAILURE

Objectives: To assess the right ventricular function (RVF) response in heart failure (HF) patients undergoing surgical ventricular reconstruction (SVR). Methods: Eighty patients (age 65 ± 9 years) with previous anterior myocardial infarction had an echocardiographic assessment of RVF before and after SVR (median 10 months). Coronary artery bypass grafting was performed in 70 patients (87%) and mitral repair in 26 patients (32%). RVF was assessed looking at the relationship between tricuspid annular plane systolic excursion (TAPSE, mm) and pulmonary artery systolic pressure (PAPs) by Doppler echocardiography as an in vivo indicator of right ventricular contractile state, considering TAPSE as a length and PAPs as a force. Results: SVR resulted in reductions in left end-diastolic volume index (from 116 ± 41 to 89 ± 24, P < 0.0001) and end-systolic volume index (from 81 ± 37 to 54 ± 21, P < 0.0001) and increases in left ventricular ejection fraction (from 32 ± 8 to 40 ± 9, P < 0.0001). TAPSE decreased (from 20 ± 4 mm to 16 ± 3 mm, P < 0.0001) and a significant reduction in PAPs (from 40 ± 15 mmHg to 36 ± 12, P < 0.02) was observed. This led to a left-sided downward shift of the TAPSE vs PAPs relationship suggesting that, although a postoperative decrease in longitudinal RVF occurred, the overall RV functional state was more advantageous due to a decrease in the afterload. Conclusions: These findings suggest a more favourable RV functional state after SVR explaining, at least partially, the benefits due to surgical remodelling. A stepwise assessment of RV performance may be helpful in accomplishing the clinical work-up of patients undergoing SVR.