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Quantitative Evaluation of Right Ventricular Workload Based on the Stroke Work Index in Patients after Right Ventricular Outflow Tract Reconstruction

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Abstract

The evaluation of right ventricular workload is sometimes complicated in patients after right ventricular outflow tract reconstruction (RVOTR) because both stenotic and regurgitation lesions are involved. In this study, we modified the right ventricular stroke work index (RVSWI) and evaluated the relationship between the modified RVSWI (mRVSWI) and patient prognosis after RVOTR.We enrolled 69 patients who underwent RVOTR (the RVOTR group), including those who needed early reoperation (early reoperation subgroup) and those who did not (follow-up subgroup), and 13 age-matched control participants (control group). Based on the catheterization results 1 year after RVOTR, we compared the mRVSWI between these groups. Additionally, we evaluated the influence of the mRVSWI on the reoperation avoidance rate and survival.The mRVSWI in the RVOTR group was significantly greater than that in the control group (17.7 ± 8.6 vs. 11.0 ± 2.7 g·m/m2, p = 0.008). The mRVSWI in the early reoperation subgroup was significantly greater than that in the follow-up subgroup (32.5 ± 11.1 vs. 15.8 ± 6.0 g·m/m2, p < 0.0001). In the follow-up subgroup, patients with an mRVSWI higher than the upper limit of normal (16.4 g·m/m2) had a greater rate of reoperation than did the other patients (p = 0.0013). One patient died suddenly, and her mRVSWI was consistently high throughout her life.We established the mRVSWI as an index that integrates the pressure and volume load on the right ventricle. Our results indicate the utility of the mRVSWI for predicting patient prognosis after RVOTR.

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Authors and Affiliations

  1. Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0329, Japan

    Takashi Honda, Manabu Takanashi, Atsushi Kitagawa, Sumito Kimura, Yoichiro Hirata & Kenji Ishikura

  2. Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Fumiaki Shikata & Kagami Miyaji

Authors
  1. Takashi Honda
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  2. Manabu Takanashi
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  3. Atsushi Kitagawa
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Contributions

All authors contributed to study design. TH, MT, AK and YH collected and analyzed the data, and drafted the manuscript. FS, KM and KI revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Takashi Honda.

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Supplementary file1 (DOCX 20 kb)

246_2024_3499_MOESM2_ESM.tif

Supplementary file2 (TIF 164 kb)— Supplemental Figure 1. The relationship between the RVSWI and mRVSWI. The relationship between the RVSWI and mRVSWI in the RVOTR group is shown. The data of patients with RVOTS with a difference of 20 mmHg or more between the RVSP and systolic pulmonary artery pressure are shown as red dots, and the data of patients without RVOTS are shown as black dots. This scatterplot demonstrated that the ratio of RVSWI to mRVSWI is lower in patients with RVOTS than those without RVOTS, strongly indicating that the RVSWI underestimates right ventricular stroke work in patients with RVOTS.

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Honda, T., Takanashi, M., Kitagawa, A. et al. Quantitative Evaluation of Right Ventricular Workload Based on the Stroke Work Index in Patients after Right Ventricular Outflow Tract Reconstruction. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03499-5

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