Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: A tricuspid annular motion–based study

Hedman, Anders; Alam, Mahbubul; Zuber, E; Nordlander, Rolf; Samad, Bassem A.

doi:10.1016/j.echo.2003.10.023

Cited by 66 publications

(60 citation statements)

References 26 publications

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“…These two measures proved to be complementary-RV FAC identified a small group of patients (5%) with overt RV hypokinesis who were at extreme risk (50% observed mortality or major morbidity), whereas RV MPI identified a larger group (24%) with subclinical RV impairment which may not otherwise be detected by visual assessment of the RV that were at high risk (26% observed mortality or major morbidity). We opted not to include measures of longitudinal RV function (tricuspid annular plane systolic excursion or tricuspid annular tissue Doppler velocity) for 2 reasons: first, these have been shown to inaccurately correlate with postoperative RV ejection fraction 29 or functional capacity 30 after cardiac surgery, and second, these require dedicated M-Mode and tissue Doppler acquisitions, which are not always available. RV FAC and MPI have the distinct advantage of being measurable offline from routinely acquired images within <5 minutes.…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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Background— Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. Methods and Results— Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. Conclusions— Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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“…The prolonged reduction in longitudinal markers remains perplexing as exercise capacity improves significantly after three months and there is no associated reduction in left ventricular function. 1,4,5 We previously demonstrated that induction of anesthesia does not alter TAPSE or S 0 . 13 It has also been suggested that reductions in markers of RV function begin during surgery, at the moment of pericardial opening.…”

Section: \0001mentioning

confidence: 95%

“…Studies have shown that measures of RV longitudinal function (base to apex displacement) are depressed after cardiac surgery, a condition that may persist for up to a month or more despite good functional recovery. [1][2][3][4][5] Finding a measure of longitudinal RV function that accurately reflects ventricular recovery would be helpful during the postoperative assessment.…”

Section: Résumémentioning

confidence: 99%

Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery – an observational study

Orman

Connelly

Albinmousa

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Patients undergoing mitral valve surgery are at risk for right ventricular (RV) dysfunction resulting from increased left atrial pressure and increased pulmonary artery impedance. Measures of longitudinal measures of RV function, such as displacement, are commonly performed but have been shown to be depressed after cardiac surgery despite good patient recovery. The aim of this observational study was to assess the early perioperative time course of longitudinal transthoracic echocardiographic (TTE) markers of RV function in a patient population undergoing mitral valve surgery. Methods Twenty patients undergoing mitral valve surgery were enrolled in this observational study. Right ventricular longitudinal measurements (tricuspid annular plane systolic excursion [TAPSE], strain, annular velocity [S 0 ], and isovolumic acceleration [IVA]) were performed using TTE and colour Doppler imaging preoperatively (day 1) and postoperatively (days 2 and 6). Comparisons were made between the preoperative and postoperative measurements. Results Adequate echocardiographic imaging was obtained for all 20 patients. The TAPSE, strain, and S 0 measures remained depressed for up to one week (i.e., day 6) after surgery compared to preoperative values. The IVA was depressed on the first postoperative day (P [ 0.001), but by day 6 it was no different from the preoperative value (P = 0.37). The median [interquartile range] time to discharge from hospital was 7 [6-9] days. Conclusion Persistent, significant depression of longitudinal markers of RV function despite functional improvement (discharge from hospital) make it difficult to assess recovery during the early perioperative period. Isovolumic acceleration, a load-independent measure of contractility, might be a more reliable measure of early recovery in RV function in this patient population. RésuméObjectif Les patients subissant une chirurgie de valve mitrale courent le risque de dysfonction du ventricule droit (VD) résultant d'une augmentation de la pression auriculaire gauche et de l'impédance artérielle pulmonaire. Des mesures des mesures longitudinales de la fonction du VD, telles que le déplacement, sont fréquentes, mais il a été démontré qu'elles étaient diminuées après une chirurgie cardiaque malgré une bonne récupération du patient. L'objectif de cette étude observationnelle était d'évaluer le décours temporel périopératoire précoce des marqueurs longitudinaux de l'échocardiographie transthoracique (ETT) de la fonction VD dans une population de patients subissant une chirurgie de valve mitrale.This study was approved by the St Michael's hospital IRB.

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“…Reduced right ventricular function is a common finding in coronary artery bypass graft surgery (CABG) which can cause heart failure and increase mortality after surgery (1)(2)(3)(4). Although the underlying mechanism is not clear, such a condition is attributed to different causes such as intraoperative ischemia, intraoperative myocardial damage, and the use of cardiopulmonary pump (CPB) (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown that intraoperative right ventricle dysfunction can last up to 6 months after the surgery (7)(8)(9). Some other studies have reported that the echocardiographic right ventricular dysfunction can last up to even 1 year after CABG (2,10); nevertheless, due to improved levels of exercise stress test, some studies have considered a minor clinical value for such disorders (2).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the effect of off-pump coronary artery bypass (OPCAB) surgery on right ventricle function using strain and strain rate imaging

Khammarnia

Hosseintash

Foroughi

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Right ventricle function significantly decreases after coronary artery bypass surgery; as one of the likely causes, such a condition is attributed to the use of cardiopulmonary pump (CPB). Because nowadays there is a tendency toward increasing use of off-pump coronary artery bypass (OPCAB) surgery, this study was conducted to evaluate the right ventricle function after this type of surgery using strain and strain rate imaging (SRI) echocardiography.Methods: This study was conducted on 30 patients, candidate for elective OPCAB surgery, between 2011 and 2012. Standard echocardiography was performed before the surgery and the right ventricle function was examined using strain and SRI echocardiography. Then patient underwent surgery, 6 days and 3 months after surgery they underwent echocardiography again and the results obtained from the three stages were compared with each other.Results: Participants included 30 patients (23 males and 7 females) with a mean age of 66±11 years.Compared to the prior of the surgery, 6 days and 3 months after the surgery there was a significant decrease in tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI) at the lateral annulus of tricuspid valve, and strain and SRI of right ventricle. However, the values obtained 3 months after surgery were significantly higher than those obtained after 6 days. In other words, the right ventricle function 6 days after the surgery had dropped, however some of the values recovered 3 months after the surgery. Conclusions:The findings of this study are consistent with other studies in this field and showed that after coronary artery surgery a decline occurs in right ventricular function. However, more detailed quantitative strain and SRI parameters which were measured in our study showed that at the early days after the OPCAB surgery there is a decline in the right ventricle function which is relatively reversible at longer intervals (3 months after surgery).Keywords: Right ventricle function; off-pump coronary artery bypass surgery (OPCAB surgery); off-pump coronary artery bypass surgery (OPCAB); strain and strain rate imaging echocardiography (strain and SRI echocardiography)

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Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: A tricuspid annular motion–based study

Cited by 66 publications

References 26 publications

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery – an observational study

Assessment of the effect of off-pump coronary artery bypass (OPCAB) surgery on right ventricle function using strain and strain rate imaging

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