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

Abstract

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.

Regional Right Ventricular Function Assessed by Intraoperative Three-Dimensional Echocardiography Is Associated With Short-Term Outcomes of Patients Undergoing Cardiac Surgery

“…The institutional regimen for standardized anesthesia during cardiac surgery and intraoperative echocardiography was described previously ( 14 , 15 ). Briefly, anesthesia was induced with midazolam, sufentanil and rocuronium.…”

Right ventricular volume-strain loops using 3D echocardiography-derived mesh models: proof-of-concept application on patients undergoing different types of open-heart surgery

“…All included patients received standardized 3D TEE during hemodynamic stability under general anesthesia both prior to sternotomy ("pre") and after sternal closure ("post"). The institutional protocol for intraoperative 3D TEE acquisition has been extensively described elsewhere (19)(20)(21)(22). In brief, a RV-focused 3D recording was performed using multi-beat acquisition to achieve sufficient frame rates for STE-based volumetry (Figure 2A).…”

“…Literature on the perioperative changes of RV mechanics following cardiac surgery is conflicting. While the effects presumably depend on the procedure, comorbidities and other perioperative variables (such as the use of CPB), most studies report a reduction of RV longitudinal function while global RV function is maintained (19,24,27,(31)(32)(33). However, systematic assessment of RV mechanics employing 3D echocardiography is only used in a limited number of these investigations, potentially underestimating the role of circumferential RV function.…”

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle

“…Having the opportunity to distinguish longitudinal, radial, and circumferential contraction [49,55] RV strain analysis allow to differentiate perioperative changes of RV function in different procedures. Although in its infancy, perioperative three-dimensional RV strain analysis offers many features to overcome the problems of two-dimensional strain assessment and may help in decision-making [71,72].…”