Outcome and Definition of Right Ventricular Dysfunction
The outcome was RVD, which was defined as the presence of severe right ventricular dilation and interventricular septal flattening (determined qualitatively by the clinician performing TTE). Tricuspid annular plane systolic excursion(TAPSE) is easily obtainable and is a measure of RV longitudinal function. TAPSE<16 mm indicates RV systolic dysfunction[9]. Anatomical M-mode was applied on the focused apical 4-chamber view of the RV to measure TAPSE. Heart failure that required inotropes for left heart failure with elevated pulmonary capillary wedge pressure(PCWP) or pulmonary congestion caused by inadequate LVAD pump speed or aortic valve insufficiency was not considered RVD. Preoperative moderate FTR was not surgically treated when the MVR was implanted and was controlled preoperatively with specific medication for HF, volume optimization and medication to decrease pulmonary vascular resistance if PH was present.