Early Postoperative Right Ventricular Dysfunction after Mitral Valve Replacement: Echocardiographic Changes and Operative Correlates in a Rheumatic Cohort

Abstract

Objectives: This study aimed to evaluate early postoperative changes in right ventricular (RV) functional parameters and to determine their association with operative characteristics in patients undergoing mitral valve replacement (MVR) for rheumatic mitral valve disease. Methods: A prospective observational study was conducted among 50 patients undergoing MVR at a tertiary cardiac center. Preoperative and early postoperative (within 48 hours) echocardiographic parameters—including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), ejection fraction (EF), and tricuspid regurgitation (TR)—were compared. RV dysfunction (RVD) was defined as FAC < 35%. Changes in RV function were correlated with operative variables, and predictors of postoperative RVD were identified using multivariable logistic regression. Results: The mean age of the cohort was 38.7 ± 12 years, with 60% female participants. Preoperatively, 36% (18/50) had RVD, of which 33.3% improved after surgery, while 66.7% exhibited persistent dysfunction. New-onset RVD occurred in 20% of patients. Significant postoperative reductions were observed in TAPSE (p = 0.013) and EF (p = 0.020), whereas PASP showed significant improvement (p = 0.005). No significant correlations were found between operative times and delta FAC. Preoperative RVD emerged as the only independent predictor of postoperative RVD (adjusted OR 4.06, 95% CI 1.16–14.21; p = 0.028). Conclusions: Early postoperative RV dysfunction is common following MVR, particularly among patients with pre-existing impairment. Operative times did not significantly influence postoperative RV performance, suggesting a multifactorial trajectory of RV recovery. Early identification and closer follow-up of high-risk patients may help improve postoperative outcomes.