Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

Abstract

Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features include its thin wall, which presents a triangular shape in a lateral view and a crescent shape in a cross-sectional view. Principal causes of RV dysfunction after cardiac surgery encompass ischemic reperfusion injury, prolonged ischemic time, choice of cardioplegia and its administration, cardiopulmonary bypass weaning characteristics, and preoperative risk factors. Post-left ventricular assist device (LVAD) implantation RV dysfunction is common but often transient, with a favorable prognosis upon resolution. There is an ongoing debate regarding the benefits of concomitant surgical repair of the RV in the presence of regurgitation. According to the literature, the gold standard techniques for assessing RV function are cardiac magnetic resonance imaging and hemodynamic assessment using thermodilution. Echocardiography is widely favored for perioperative RV function evaluation due to its accessibility, reproducibility, non-invasiveness, and cost-effectiveness. Although other techniques exist for RV function assessment, they are less common in clinical practice. Clinical management strategies focus on early detection and include intravenous drugs (inotropes and vasodilators), inhalation drugs (pulmonary vasodilators), ventilator strategies, volume management, and mechanical support. Bridging research gaps in this field is crucial to improving clinical outcomes associated with RV dysfunction in the near future.

Switching from VA-ECMO to a Percutaneous right Ventricular assist device as a Bridge to Recovery in a Case of right Ventricular Myocardial Infarction

“…RVF due to acute myocardial infarction (MI) is rare but is associated with high morbidity and mortality [6]. This condition can occur in a perioperative context of cardiac surgery [7]. In post-MI RVF, RV contractile function becomes severely impaired, resulting in a decrease in RV systolic pressure, an increase in end-diastolic volume, and an increase in end-diastolic pressure.…”

Circulating Biomarkers in Pulmonary Arterial Hypertension: An Update

“…Finally, a few studies examined different biomarkers for RV dysfunction detection in the perioperative setting, and their validation is warranted before clinical application [110]. We hope for further research in this direction.…”