Total Ischemia Time Alters the Longitudinal and Circumferential Shortening of the Right Ventricle in Transplanted Hearts

Ahlgren, Bryan; Puskás, Ferenc; Seres, Tamás

doi:10.1177/1089253211426936

Cited by 7 publications

(4 citation statements)

References 15 publications

(18 reference statements)

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“…18 The reasons for these changes have not yet been determined, although a number of mechanisms have been proposed. 16,[19][20][21][22] As has been shown, TAPSE was particularly low in patients after heart transplantation. In these patients, RV dysfunction is a common complication, 23 which occurs as a result of a poor myocardial protection, a prolonged donor ischemic time, and a donor right ventricle not adapted to elevated pulmonary vascular resistance in the recipient, as a consequence of the end stage heart failure.…”

Section: Discussionmentioning

confidence: 79%

Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction

Gigorro¹,

Renes²,

Mayordomo

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 79%

Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction

Gigorro¹,

Renes²,

Mayordomo

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…Very few hypotheses of the different factors, which may explain this impairment of longitudinal systolic function in HTRs, have been tested to date. Some of these variables are surgical factors, such as the total ischemic time which may lead to RV myocardial injuries. However, longitudinal dysfunction has also been described in different populations undergoing other types of cardiac surgery .…”

Section: Discussionmentioning

confidence: 99%

Impact of right ventricular systolic function after heart transplantation on exercise capacity

et al. 2020

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Background: Right ventricular (RV) systolic parameters are difficult to assess in heart transplant recipients (HTRs) compared to healthy people because of discordant data, and their impact on exercise capacity remains undefined. We sought to retrospectively assess the impact of RV systolic function on exercise capacity after heart transplantation. Methods:We analyzed data from 61 HTRs who underwent transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR), and exercise capacity assessment by 6-minute walking test (6MWT) and cardiopulmonary exercise testing (CPET) at 1-and 2-year follow-ups. Results: Transthoracic echocardiography RV longitudinal systolic function includingtricuspid annular plan systolic excursion (TAPSE), peak systolic S′ wave tricuspid annular velocity (PSVtdi) and RV free wall longitudinal strain was decreased at 1 year (respectively, 15 ± 3 mm, 10 ± 3 cm/s, and −19 ± 5%) and at 2 years (respectively, 15 ± 3 mm, 10 ± 2 cm/s, and −20 ± 5%) with no significant difference between both evaluations; meanwhile, RV ejection fraction (RVEF) measured by CMR was preserved. Mean percentage of predicted peak oxygen consumption was altered, but improved between the first and second year (55 ± 18 vs 60 ± 18%, P = .038). PSVtdi was weakly correlated with 6MWT distance (r = .426, P = .017) and RVEF with the predicted distance at 6MWT (r = .410, P = .027) at the 1-year follow-up. Conclusions: Despite decreasing values, RV longitudinal systolic function has a weak impact on exercise capacity of HTRs. PSVtdi and RVEF are the most pertinent parameters to assess the impact of RV systolic function on exercise capacity after heart transplantation. These results should lead to redefine normal RV systolic function thresholds for HTRs. K E Y W O R D S cardiopulmonary exercise testing, echocardiography, functional capacity, heart transplantation, right ventricle | 707 VERSET ET al.

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“…Donorrecipient size matching is critical, with size mismatch (smaller donor hearts implanted in to larger recipients) being associated with an increased risk of RVD, particularly in those recipients with pre-existing pulmonary hypertension (Shah et al 2020). Organ procurement and preservation technique along with ischaemic time (Ahlgren et al 2011), and manual handling, can all contribute to increased risk of RVD. In addition, the recipient often has a degree of pulmonary hypertension as a result of end-stage heart failure.…”

Section: Cardiac Transplantation and Left Ventricular Assist Device I...mentioning

confidence: 99%

Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications

Shelley,

McAreavey,

McCall

2024

Perioper Med

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In this edition of the journal, the Perioperative Quality Initiative (POQI) present three manuscripts describing the physiology, assessment, and management of right ventricular dysfunction (RVD) as pertains to the perioperative setting. This narrative review seeks to provide context for these manuscripts, discussing the epidemiology of perioperative RVD focussing on definition, risk factors, and clinical implications. Throughout the perioperative period, there are many potential risk factors/insults predisposing to perioperative RVD including pre-existing RVD, fluid overload, myocardial ischaemia, pulmonary embolism, lung injury, mechanical ventilation, hypoxia and hypercarbia, lung resection, medullary reaming and cement implantation, cardiac surgery, cardiopulmonary bypass, heart and lung transplantation, and left ventricular assist device implantation. There has however been little systematic attempt to quantify the incidence of perioperative RVD. What limited data exists has assessed perioperative RVD using echocardiography, cardiovascular magnetic resonance, and pulmonary artery catheterisation but is beset by challenges resulting from the inconsistencies in RVD definitions. Alongside differences in patient and surgical risk profile, this leads to wide variation in the incidence estimate. Data concerning the clinical implications of perioperative RVD is even more scarce, though there is evidence to suggest RVD is associated with atrial arrhythmias and prolonged length of critical care stay following thoracic surgery, increased need for inotropic support in revision orthopaedic surgery, and increased critical care requirement and mortality following cardiac surgery. Acute manifestations of RVD result from low cardiac output or systemic venous congestion, which are non-specific to the diagnosis of RVD. As such, RVD is easily overlooked, and the relative contribution of RV dysfunction to postoperative morbidity is likely to be underestimated.We applaud the POQI group for highlighting this important condition. There is undoubtedly a need for further study of the RV in the perioperative period in addition to solutions for perioperative risk prediction and management strategies. There is much to understand, study, and trial in this area, but importantly for our patients, we are increasingly recognising the importance of these uncertainties.

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Total Ischemia Time Alters the Longitudinal and Circumferential Shortening of the Right Ventricle in Transplanted Hearts

Abstract: Total ischemia time of the transplanted heart may play a role in deterioration of longitudinal and circumferential shortening of the RV.

Cited by 7 publications

References 15 publications

Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction

Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction

Impact of right ventricular systolic function after heart transplantation on exercise capacity

Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications

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