title: Preoperative assessment of left ventricular diastolic function and right ventricular systolic function have independent and incremental prognostic value in prediction of early postoperative mortality in redo valve surgery.
abstract: OBJECTIVE
  Redo valve surgery is associated with increased risk of mortality that may be underestimated by current risk scores. In this study, we hypothesized that additional echocardiographic assessment of left ventricular diastolic and right ventricular systolic function would have independent prognostic value in the prediction of early postoperative mortality in patients undergoing redo valve surgery.
  
  
  METHODS
  We prospectively evaluated 145 patients who underwent redo mitral or aortic valve surgery at our center. All patients underwent comprehensive preoperative echocardiography. The primary outcome was all-cause mortality at 30 days.
  
  
  RESULTS
  The 30-day mortality rate was 11.7%. Independent of EuroSCORE II both preoperative left ventricular diastolic dysfunction and right ventricular systolic dysfunction were a significant multivariable predictors of 30-day mortality (HR 5.47; 95% CI 1.12-26.74, P = 0.036 and HR 4.09; 95% CI 1.11-15.07, P = 0.035, respectively) in addition to EuroSCORE II. Diastolic dysfunction remained significant when added to other clinically significant variables. The assessment of both parameters increased the discriminatory power of EuroSCORE II for prediction of early mortality and the combination identified a group at very high risk of mortality.
  
  
  CONCLUSIONS
  Comprehensive preoperative echocardiography including assessment of left ventricular diastolic and right ventricular systolic function has independent prognostic value over and above EuroSCORE II in the prediction of early postoperative mortality in patients undergoing redo valve surgery. The results of preoperative echocardiography should be taken into account during the selection and perioperative management of patients undergoing redo valvular surgery.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ify
authors.initials: I
authors.lastname: Mordi
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tzemos
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D003971:Diastole / Q000502:physiology; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D013599:Systole / Q000502:physiology; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality
keywords: diastolic function; echocardiography; right ventricular dysfunction; valvular heart surgery