Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled Study

Eskandr, Ashraf M.; Metwally, Ahmed A.; Elkassem, Montasser S. Abu; Sadik, Sadik A; Elmiligy, Ashraf E.; Mourad, M; Hussein, Lamiaa

doi:10.1053/j.jvca.2018.04.032

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…23 However, it can be affected by poor imaging, 25 previous cardiac surgery due to tethering of the RV to the sternum, 24 and load dependency. 23,40 Muraru et al showed that inclusion of interventricular septum in strain analysis yields significantly different strain values from the value from analyzing RV free wall alone. Moreover, in their study, RVGLS, as compared to RVFWS, correlated better with pulmonary artery systolic pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Speckle tracking carries the advantage of angle‐independent assessment of myocardial movement and is sensitive to subendocardial damage, which produces the strain 23 . However, it can be affected by poor imaging, 25 previous cardiac surgery due to tethering of the RV to the sternum, 24 and load dependency 23,40 . Muraru et al showed that inclusion of interventricular septum in strain analysis yields significantly different strain values from the value from analyzing RV free wall alone.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of right ventricular function following left ventricular assist device (LVAD) implantation—The role of speckle‐tracking echocardiography: A meta‐analysis

et al. 2020

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Background: Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle-tracking echocardiography (STE) showed promising results. We performed systematic review and meta-analysis of published literature. Methods: We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random-effects model.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of right ventricular function following left ventricular assist device (LVAD) implantation—The role of speckle‐tracking echocardiography: A meta‐analysis

et al. 2020

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“…17 However, it can affected by poor imaging, 19 previous cardiac surgery due to tethering of the RV to the sternum, 18 and load dependency. 17,38 Similarly, TTE-derived GLS showed discriminatory power to predict post-operative RVF. Muraru et al .…”

Section: Discussionmentioning

confidence: 94%

Assessment of Right Ventricular Function Following Left Ventricular Assist Device Implantation – The Role of Speckle-Tracking Echocardiography: A Meta-Analysis.

Barssoum¹,

Altibi²,

Rai³

et al. 2020

Preprint

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Background: Right ventricular failure (RVF) following Left Ventricular Assist Device (LVAD) implantation is associated with worse outcomes. Prediction and early identification of RVF with speckle-tracking echocardiography (STE) has been proposed. Methods: We queried multiple databases for articles reporting on pre-operative/intraoperative global longitudinal strain (GLS) and free-wall strain (FWS) in LVAD recipients. We performed a systematic review and meta-analysis of published literature. The standard mean difference (SMD) in GLS and FWS in patients with and without RVF postoperatively was pooled using random effects model. Results: Fifteen studies, with a total of 967 LVAD recipients were included. There was statistically significant difference in GLS among patients who did and did not develop RVF; SMD=-3.09 (95% CI:-4.62 to-1.57; p-value <0.0001). There was significant difference in FWS between two groups; SMD:-2.75 (95% CI:-3.72 to-1.79; p-value <0.0001). Upon subgroup analysis of imaging modality, transthoracic echocardiography (TTE)-derived GLS and FWS remained predictive for RVF with SMD of-3.97 (95% CI:-5.40 to-2.54; p-value <0.001) and-3.05 (95% CI:-4.11 to-1.99; p-value <0.001), respectively. However, there was no significant difference between RVF and non-RVF groups upon using transesophageal echocardiography (TEE) to assess GLS and FWS. Conclusion: GLS and FWS assessment of the RV by STE is a useful tool to predict postoperative RVF in LVAD recipients. While the predictive role of TTE was robust, the TEE-derived measures seemed to be less predictive. Future studies need to specify the strain cutoff value that can predict the adverse outcome of RVF ABSTRACT Background: Right ventricular failure (RVF) following Left Ventricular Assist Device (LVAD) implantation is associated with worse outcomes. Prediction and early identification of RVF with speckle-tracking echocardiography (STE) has been proposed. Methods: We queried multiple databases for articles reporting on pre-operative/intraoperative global longitudinal strain (GLS) and free-wall strain (FWS) in LVAD recipients. We performed a systematic review

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“…In a previously mentioned study, dobutamine was shown to have a significant increase in HR compared with milrinone; therefore, milrinone may be preferred in an individual with heart rates that are already elevated. 17 It is postulated that the increase in HR by dobutamine may be due to its direct b-adrenoceptor activation which increases the automaticity of the sinoatrial node and increases conduction through the atrioventricular node and ventricles. Milrinone has no direct activity on the sinoatrial node although it may provoke reflex tachycardia in response to vasodilation and a fall in PCWP.…”

Section: Approach To Managementmentioning

confidence: 99%

Considerations for Inotrope and Vasopressor Use in Critically Ill Patients With Pulmonary Arterial Hypertension

Adie

Abdul-Aziz

Ketcham

et al. 2022

Journal of Cardiovascular Pharmacology

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Pulmonary arterial hypertension (PAH) is a rare and progressive cardiopulmonary disease, characterized by pulmonary vasculopathy. The disease can lead to increase pulmonary arterial pressures and eventual right ventricle failure due to elevated afterload. The prevalence of PAH in patients admitted to the intensive care unit (ICU) is unknown, and pulmonary hypertension (PH) in the ICU is more commonly the result of left heart disease or hypoxic lung injury (PH due to left heart disease and PH due to lung diseases and/or hypoxia, respectively), as opposed to PAH. Management of patients with PAH in the ICU is complex as it requires a careful balance to maintain perfusion while optimizing right-sided heart function. A comprehensive understanding of the underlying physiology and underlying hemodynamics is crucial for the management of this population. In this review, we summarized the evidence for use of vasopressors and inotropes in the management of PH and extrapolated the data to patients with PAH. We strongly believe that the understanding of the hemodynamic consequences of inotropes and vasopressors, especially from data in the PH population, can lead to better management of this complex patient population.

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Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled Study

Cited by 17 publications

References 19 publications

Assessment of right ventricular function following left ventricular assist device (LVAD) implantation—The role of speckle‐tracking echocardiography: A meta‐analysis

Assessment of right ventricular function following left ventricular assist device (LVAD) implantation—The role of speckle‐tracking echocardiography: A meta‐analysis

Assessment of Right Ventricular Function Following Left Ventricular Assist Device Implantation – The Role of Speckle-Tracking Echocardiography: A Meta-Analysis.

Considerations for Inotrope and Vasopressor Use in Critically Ill Patients With Pulmonary Arterial Hypertension

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