CONGRESS ABSTRACT

Background Right-ventricular(RV)dysfunction is frequent after valve surgery,but static postoperative measurements provide a limited understanding of RV adaptation.We aimed to characterise 6-month RV functional trajectories and assess their prognostic relevance,integrating RV–pulmonary arterial(PA)coupling with clinical outcomes Methods Prospective single-centre study including 147 adults undergoing elective valve surgery(aortic,mitral or combined±tricuspid);isolated CABG was excluded.Echocardiography was performed at baseline,predischarge,3,and 6 months.RV assessment included TAPSE,S’,RV free-wall longitudinal strain(RV-LS)and TAPSE/PASP(RV–PA coupling).Perioperative pharmacological management followed an institutional protocol and was included as covariates;intraoperative parameters(bypass and cross-clamp times)were recorded.Outcomes were prolonged mechanical ventilation,ICU stay,acute right-sided HF and 6-month HF readmissions.Longitudinal RV patterns were identified using latent trajectory modelling;predictors and outcomes were analysed with multivariable regression Results 3 trajectories were identified:(a)Rapid-recovery(34%):early TAPSE decline predischarge with recovery at 6 months,stable RV-LS and preserved coupling;(b)Delayed-recovery(26%):marked early impairment with partial improvement and transient TAPSE/PASP<0.35;(c)Persistent-dysfunction(40%):sustained TAPSE≤13 mm and RV-LS≥−14% with RV–PA uncoupling(TAPSE/PASP≤0.30).Baseline pulmonary hypertension and pre-operative RV-LS impairment independently predicted allocation to the persistent-dysfunction trajectory(p<0.01),whereas bypass and cross-clamp times were not independently associated with trajectories or outcomes.The persistent-dysfunction group showed higher rates of prolonged ventilation,acute right-sided HF,longer ICU stay and more 6-month HF readmissions(p≤0.02).Predischarge RV–PA uncoupling(TAPSE/PASP<0.35)independently predicted HF readmission,offering incremental prognostic value over TAPSE Conclusion RV function after valve surgery does not follow a uniform postoperative course. 3 trajectory-based phenotypes were identified,and persistent RV dysfunction with RV–PA uncoupling defined a high-risk subgroup associated with early adverse outcomes.A trajectory-based assessment integrating TAPSE,RV-LS and TAPSE/PASP may enhance postoperative risk stratification and guide structured follow-up in vulnerable patients.This approach may help target closer clinical surveillance and follow-up strategies