Denault AY, Couture P, Beaulieu Y, Haddad F, Deschamps A, Nozza A, Pagé P, Tardif JC, Lambert J. Right Ventricular Depression After Cardiopulmonary Bypass for Valvular Surgery.
J Cardiothorac Vasc Anesth 2015;
29:836-44. [PMID:
25976606 DOI:
10.1053/j.jvca.2015.01.011]
[Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
To assess if right ventricular (RV) dysfunction is associated with increased mortality after cardiac surgery.
DESIGN
Post-hoc analysis of a single-center double-blind randomized controlled trial.
SETTING
University hospital.
PARTICIPANTS
A total of 120 patients undergoing simple or complex valvular surgery.
INTERVENTIONS
Patients were randomized to receive intravenous amiodarone or placebo intraoperatively. As secondary analysis, patients were divided into those requiring or not requiring postoperative inotropic agents.
MEASUREMENTS AND MAIN RESULTS
After cardiopulmonary bypass (CPB), there were significant increases in heart rate, cardiac index, systolic and mean arterial pressures, central venous pressure and pulmonary capillary wedge pressure with reduction in systemic vascular resistance (p<0.05). Right ventricular end-systolic area became larger in those without inotropes and tricuspid annular plane systolic excursion was reduced in all patients; mitral annular systolic velocities were higher in patients receiving inotropes. Both right- and left-sided Doppler signals were altered significantly after CPB, which may be attributed to increased filling pressure. Inotropic agents were required in 56 patients after CPB (47%). The use of inotropic agents was associated with increased left and right atrial velocities (p<0.05). There were no differences in postoperative complications between groups; however, the number of deaths at 6 years was increased in patients who received inotropes after CPB (p = 0.0247).
CONCLUSIONS
The increases in right-sided dimensions after CPB are associated with reduction in RV function and increased biventricular filling pressure, suggesting worsening biventricular function and interventricular dependence. Inotropic medications were associated with unaltered RV dimensions and increased biatrial activity.
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