Preoperative TAPSE/PASP Ratio and Prolonged Intensive Care Unit Stay After Mitral Valve Replacement: An Exploratory Assessment of In-Hospital Mortality

Objective: To evaluate whether the preoperative echocardiographic ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) is associated with prolonged intensive care unit (ICU) stay after isolated mitral valve replacement (MVR) for primary mitral regurgitation and, in an exploratory analysis, with in-hospital mortality.
Method: This single-center, retrospective study included 179 adults. The primary outcome was prolonged ICU stay (>48 hours), and in-hospital mortality was a secondary, exploratory outcome. Logistic regression was used to analyze ICU stay in the cohort excluding patients who died (n = 166), and Firth's penalized regression was used to analyze mortality. Sensitivity analyses incorporated death into the outcome, excluded moderate tricuspid regurgitation as a covariate, and assessed the incremental value of the ratio beyond EuroSCORE II.
Results: The TAPSE/PASP ratio demonstrated good discrimination for prolonged ICU stay (area under the curve [AUC], 0.856; bootstrap-corrected AUC, 0.856), outperforming TAPSE and PASP individually. Each 0.1-unit increase in the ratio was independently associated with lower odds of prolonged ICU stay (odds ratio [OR], 0.45; P < 0.001). This association remained materially unchanged when moderate tricuspid regurgitation was excluded as a covariate (OR, 0.40) or when death was incorporated into the outcome (OR, 0.45). Adding the ratio to EuroSCORE II improved discrimination (AUC, 0.683 to 0.853; P < 0.001). At the exploratory Youden-derived cutoff of 0.576, prolonged ICU stay occurred in 81.3% of patients with lower ratios and 20.2% of those with higher ratios (P < 0.001). In an exploratory analysis based on only 13 deaths, a lower ratio was also associated with in-hospital mortality (AUC, 0.772).
Conclusion: A lower TAPSE/PASP ratio was independently associated with prolonged ICU stay, outperformed its individual components, and provided additional discriminative value beyond EuroSCORE II. Its association with mortality remains exploratory. This simple index may aid preoperative risk stratification, pending external validation.

Keywords: In-hospital mortality, intensive care unit length of stay, mitral valve replacement, right ventricular–pulmonary arterial coupling, TAPSE/PASP ratio.