Mitral valve repair for dilated cardiomyopathy: predictive role of right ventricular dysfunction

Aims To evaluate the impact of right ventricular (RV) dysfunction on early and mid-term outcome of
patients with ischaemic or dilated cardiomyopathy (DCM) undergoing mitral valve annuloplasty.
Methods and results From January 1997 to December 2005, 111 patients with DCM (89 ischaemic,
22 non-ischaemic) were enrolled in this retrospective study. Mean age was 67+10 years. Average
pre-operative NYHA class was 3.0+0.6. Tricuspid annular plane systolic excursion (TAPSE), tricuspid
annular pleak systolic velocity (TAPSV), and RV fractional area change were considered as an index of
RV function. A strong relationship between TAPSE and TAPSV were found (r ¼ 0.76). Thirty-day mortality
was 10.8%. Five-year survival and possibility to be alive in NYHA classes I–II were 66.5+5.0 and 59.5+
5.0%. TAPSE, TAPSV, and MV coaptation depth (MVCD) were found to be risk factors for worse early and
mid-term outcome; functional class impaired mid-term outcome. ROC analysis identified TAPSE12
mm, TAPSV10 cm/s, and MVCD.10 mm as predictive cut-offs.
Conclusion Pre-operative assessment of some echocardiographic parameters (TAPSE, TAPSV) is very
easy, low cost, and provides accurate information on RV function. A good pre-operative clinical compensation
has to be necessarily reached before the operation. MVCD should be evaluated to decide surgical
strategy (repair or replace).