Perioperative right ventricular function and dysfunction in adult cardiac surgery—focused review (part 2—management of right ventricular failure)

Varma, Praveen Kerala; Srimurugan, Balaji; Jose, Reshmi Liza; Krishna, Neethu; Valooran, George Jose; Jayant, Aveek

doi:10.1007/s12055-021-01226-w

Cited by 6 publications

(7 citation statements)

References 58 publications

(87 reference statements)

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“…A good surrogate of RVEF is the right ventricular fractional area change (RVFAC), which is the fractional difference of the area of the RV between end-diastole and end-systole; it is calculated by tracing the RV endocardium manually in a four chambers view using 2D echocardiography. An RVFAC < 35% is considered pathological [18,62]. Anyway, it must be noted that RVFAC provides a two-dimensional assessment of RV function and is reliant on manual tracing of the RV endocardium.…”

Section: The Role Of the Echocardiography: Tapse Rvef Rvfac Tdi Strai...mentioning

confidence: 99%

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

Mattei,

Strumia,

Benedetto

et al. 2023

JCM

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Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features include its thin wall, which presents a triangular shape in a lateral view and a crescent shape in a cross-sectional view. Principal causes of RV dysfunction after cardiac surgery encompass ischemic reperfusion injury, prolonged ischemic time, choice of cardioplegia and its administration, cardiopulmonary bypass weaning characteristics, and preoperative risk factors. Post-left ventricular assist device (LVAD) implantation RV dysfunction is common but often transient, with a favorable prognosis upon resolution. There is an ongoing debate regarding the benefits of concomitant surgical repair of the RV in the presence of regurgitation. According to the literature, the gold standard techniques for assessing RV function are cardiac magnetic resonance imaging and hemodynamic assessment using thermodilution. Echocardiography is widely favored for perioperative RV function evaluation due to its accessibility, reproducibility, non-invasiveness, and cost-effectiveness. Although other techniques exist for RV function assessment, they are less common in clinical practice. Clinical management strategies focus on early detection and include intravenous drugs (inotropes and vasodilators), inhalation drugs (pulmonary vasodilators), ventilator strategies, volume management, and mechanical support. Bridging research gaps in this field is crucial to improving clinical outcomes associated with RV dysfunction in the near future.

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Section: The Role Of the Echocardiography: Tapse Rvef Rvfac Tdi Strai...mentioning

confidence: 99%

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

Mattei,

Strumia,

Benedetto

et al. 2023

JCM

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“…Blood loss, platelet dysfunction and coagulopathy often mandate transfusion, which can also contribute to right HF [38]. Finally, myocardial stunning [39], pericardiotomy-associated changes in RV contraction [40,41], pulmonary hypertension [42], and inadvertent air embolism to the right coronary artery [43] may all contribute to acute RV dysfunction.…”

Section: Vectors Of Ventricular Contraction (A) In the Normal Heart T...mentioning

confidence: 99%

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Alexy¹,

Burke²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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A host of complications are common after left ventricular assist device (LVAD) surgery. Perhaps none is more challenging to manage than recurrent heart failure (HF). HF in an LVAD patient is associated with substantial morbidity and increased mortality. HF can occur early or late, can present abruptly or insidiously, and can be due to an array of LVAD-specific problems including pump thrombosis and cannula obstruction, or intrinsic cardiac problems such as right ventricular failure or valvular disease. These disparate etiologies require specific testing and distinct therapeutic strategies. This chapter reviews the causes of recurrent HF after LVAD surgery with particular attention to evaluation and management strategies that can identify and treat these distinct etiologies.

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“…Anecdotally, the authors have witnessed significant improvements in load-dependent indices of RV function (e.g., TAPSE and FAC) among patients with preexisting RV dysfunction after receiving continuous intravenous diuresis for several days while undergoing optimization for TTVI. Typically, large amounts of fluid need to be removed in the congested patient to show RV function improvement owing to the flatness of the Frank-Starling RV curve [47 ▪ ]. With severely depressed RV function, use of low-dose milrinone or levosimendan have been shown to improve RV contractility and reduce pulmonary vascular resistance.…”

Section: Considerations In Right Heart Failurementioning

confidence: 99%

“…Initiation of intravenous diuresis (with or without inotropes depending upon hemodynamic status and baseline RV function), re-assessment with echocardiography and invasive hemodynamics prior to intervention to assess for RV reserve, followed by maintenance and slow weaning of these medications for several days postprocedure – especially in those with known severe RV dilation and dysfunction – are likely needed to optimize TTVI success and tolerance. In circumstances of refractory RV shock, consideration should be given to right-sided mechanical circulatory support (e.g., RV Impella; Abiomed, Danvers, MA, USA) across the novel tricuspid or caval prosthesis along with initiation of continuous renal replacement therapy [47 ▪ ].…”

Section: Considerations In Right Heart Failurementioning

confidence: 99%

A comprehensive overview of surgical and transcatheter therapies to treat tricuspid regurgitation in patients with heart failure

Chen,

Altisent,

Puri

2023

Current Opinion in Cardiology

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Purpose of review The unique pathophysiologic considerations of severe tricuspid regurgitation (TR) have led to advancements in surgical and transcatheter treatments. The purpose of this review is to highlight the current surgical and transcatheter tricuspid valve interventions (TTVI) to functional TR. Recent findings Surgical repair with ring annuloplasty consistently demonstrates better outcomes than surgical replacement or other repair approaches. However, surgical uptake of TR correction remains relatively low, and operative mortality rates are still high owing to multiple comorbidities and advanced tricuspid valve disease/right ventricular dysfunction at time of referral. Pivotal trials for tricuspid transcatheter edge-to-edge repair (T-TEER) and transcatheter TV replacement (TTVR) indicate improved quality of life compared to medical therapy alone for high-surgical-risk patients with severe symptomatic TR. Trials are underway to assess caval valve implantation (CAVI), which holds hope for many severe TR patients who are not ideal candidates for T-TEER or orthotopic TTVR. Peri-procedural optimization of right ventricular function remains critical to promote both device success and patient outcomes. Summary Clinical outcomes after surgical TV intervention are poor, often due to intervening late in the disease course of TR. TTVI covers a treatment gap for patients deemed inoperable or high-surgical-risk, but earlier referral for TV interventions is still important prior to patients developing multiorgan dysfunction from chronic untreated TR.

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Perioperative right ventricular function and dysfunction in adult cardiac surgery—focused review (part 2—management of right ventricular failure)

Cited by 6 publications

References 58 publications

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

Recurrent Heart Failure after Left Ventricular Assist Device Placement

A comprehensive overview of surgical and transcatheter therapies to treat tricuspid regurgitation in patients with heart failure

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