Parameters of longitudinal systolic function, i.e. tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity (PSV) of tricuspid annulus, are used to quantify RV function in daily practice. Changes in TAPSE and PSV after cardiac surgery have been described for many years with almost no data regarding their clinical significance.

To test whether early postoperative decline in right ventricular (RV) longitudinal function is predictive of long-term outcomes after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS).

Between January 2009 and December 2015, we prospectively explored all consecutive patients referred to our cardiovascular surgery department for AVR presenting with severe AS, normal left ventricular ejection fraction (>50%) and TAPSE (>14mm). TAPSE and PSV were assessed 7 days after cardiac surgery for all patients and 1-year after AVR in a subgroup of 100 patients. Patients were followed for major events (ME), i.e. cardiovascular death, cardiac hospitalization, acute heart failure and stroke.

Among a total of 752 patients, 135 patients presented poor acoustic window precluding reliable post-operative measurement of RV parameters. Six hundred and seventeen patients were followed-up for ME. TAPSE and PSV were severely decreased after surgery (P<0.0001) with an incomplete but significant recovery 1-year after AVR. Longer cardio-pulmonary bypass duration was the only independent parameter associated with more important decrease in RV function after AVR. After a mean follow-up of 4±2.3 years, no association was shown between early postoperative alteration in TAPSE and long-term prognosis (P=0.21 by Log-rank test for trend for ME) (Fig. 1).

The early and severe postoperative decline in RV longitudinal function reverses within a year and is not predictive of long-term outcomes after AVR.