Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy

Singh, A. K.; Huang, Xiaojie; Dai, Lu; Wyler, D.; Alfirevic, Andrej; Blackstone, Eugene H.; Pettersson, Gösta; Duncan, Andra E.

doi:10.1016/j.jtcvs.2019.04.035

Cited by 37 publications

(19 citation statements)

References 26 publications

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“…Some reports demonstrated as patients undergoing cardiac surgery show a reduction of longitudinal RV contraction up to 40% that can persist even for months after surgery 23‐25 . Singh et al 26 have recently demonstrated in a cohort of 109 patients as the RV function reduction starts soon after CPB discontinuation, with the greatest change after chest closure, regardless of the procedure and the chest access; TAPSE decreased from 2.2 to 1.4 and FAC from 46% to 38%. This reduction seems to be CPB‐correlated or due to cardioplegic arrest 25‐27 .…”

Section: Discussionmentioning

confidence: 98%

Right ventricular assessment can improve prognostic value of Euroscore II

et al. 2020

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Background The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery. Methods This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end‐diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'‐wave using tissue Doppler imaging (TDI‐S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC <35%, TAPSE <17 mm, and TDI S' <9.5 mm Results Among the entire cohort, 624 (70%) showed normal RV, 92 (10%) isolated RV dilatation, 154 (17%) isolated RV dysfunction, and 25 (3%) both RV dilatation and dysfunction. Non‐surviving patients showed a significantly higher rate of RV alteration at multivariable analysis, RV status was found to be an independent predictor for higher in‐hospital mortality beside Euroscore II. Conclusions This prospective multicenter observation study shows the importance to assess RV preoperatively and to include both RV function and dimension in a risk score model such as Euroscore II to implement its predictivity, since PH cannot always mirror the status of the right ventricle.

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Section: Discussionmentioning

confidence: 98%

Right ventricular assessment can improve prognostic value of Euroscore II

et al. 2020

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“…Over the last few decades, there has been substantial debate regarding RV contraction patterns and their alterations during RV stress [ 23 ]. In the setting of cardiac surgery, various studies have focused on the adaptive mechanisms regarding RV contraction after sternotomy, pericardiotomy, cardioplegia and cardiopulmonary bypass [ 7 , 10 – 12 ]. Intraoperative TEE is known to have the potential to have a major impact on surgical decision-making [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pericardiotomy – as mentioned above – has been frequently discussed to be a major contributor to reduced longitudinal RV shortening [ 29 ]. However, altered contraction after pericardial incision and closure appears to have long-term effects due to a switch in RV geometry rather than initially affecting longitudinal fiber shortening directly [ 10 ]. Decreased coronary blood flow – possibly induced by pericardiotomy or cardioplegia – usually leads to transient inner myocardial wall ischemia [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, longitudinal RV functiondescribing the isolated contribution of baso-apical shortening to pressure generation and volume ejectionhas been identified as an essential contributor to RV function in various conditions [2][3][4][5][6]. To date, heterogeneous data regarding global and longitudinal RV function after adult cardiac surgery exist but the available data point to a change in the sense of maintaining global but decreasing longitudinal function [7][8][9][10][11][12][13]. Although two-dimensional (2D) echocardiography is widely used for these analyses, 3D echocardiography is advantageous considering the complex geometry and heterogeneous myocardial deformation patterns of the right ventricle when compared to cardiac magnetic resonance [14].…”

Section: Introductionmentioning

confidence: 99%

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Acute changes of global and longitudinal right ventricular function: an exploratory analysis in patients undergoing open-chest mitral valve surgery, percutaneous mitral valve repair and off-pump coronary artery bypass grafting

Keller

Heller

Lang

et al. 2020

Cardiovasc Ultrasound

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Background: Right ventricular (RV) function is an important prognostic indicator. The acute effects of cardiac interventions or cardiac surgery on global and longitudinal RV function are not entirely understood. In this study, acute changes of RV function during mitral valve surgery (MVS), percutaneous mitral valve repair (PMVR) and offpump coronary artery bypass surgery (OPCAB) were investigated employing 3D echocardiography. Methods: Twenty patients scheduled for MVS, 23 patients scheduled for PMVR and 25 patients scheduled for OPCAB were included retrospectively if patients had received 3D transesophageal echocardiography before and immediately after MVS, PMVR or OPCAB, respectively. RV global and longitudinal function was assessed using a 3D multiparameter set consisting of global right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), longitudinal contribution to RVEF (RVEF long) and free wall longitudinal strain (FWLS). Results: Longitudinal RV function was significantly depressed immediately after MVS, as reflected by all parameters (RVEF long : 20 ± 5% vs. 13 ± 6%, p < 0.001, TAPSE: 13.1 ± 5.1 mm vs. 11.0 ± 3.5 mm, p = 0.04 and FWLS: −20.1 ± 7.1% vs.-15.4 ± 5.1%, p < 0.001, respectively). The global RVEF was slightly impaired, but the difference did not reach significance (37 ± 13% vs. 32 ± 9%, p = 0.15). In the PMVR group, both global and longitudinal RV function parameters were unaltered, whereas the OPCAB group showed a slight reduction of RVEF long only (18 ± 7% vs. 14 ± 5%, p < 0.01). RVEF long yielded moderate case-to-case but good overall reproducibility.

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“…[1][2][3][4][5][6][7] Through the years, studies have focused on identifying more sensitive markers of RV dysfunction. The study of Singh and colleagues 8 in this issue of the Journal brings novel insights into perioperative changes in RV function, focusing on annular, longitudinal shortening (RV myocardial strain) as well as area changes. Its strength lies in describing the dynamic of RV changes at key perioperative moments and in variable types of surgery.…”

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confidence: 99%