Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit?

Abstract

Echocardiographic reduction of RV function, measured using TAPSE, is a well described phenomenon after cardiac surgery. The aim of the present study was to investigate the relation between the modality of pericardial opening (lateral versus anterior) and the postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair. 34 patients with severe mitral regurgitation due to mitral valve prolapse underwent traditional (sternotomy) operation (Group A) or minimally invasive surgery with right anterolateral thoracotomy (Group B). A postoperative TAPSE fall was found in both groups. Group A experienced a significant postoperative TAPSE fall versus Group B with p < 0.0001.

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

“…The apparent deficit in RV function after MV surgery, when evaluated exclusively by the parameters of the longitudinal contractions, has been described in previous studies. 26,27 Nevertheless, the observed alteration of RV contraction pattern is not specific to MVR as similar shift was reported by Raina et al in patients undergoing heart transplantation or isolated coronary artery bypass surgery. 28 Different causes have been proposed to explain this loss in longitudinal RV performance, such as geometric changes in the RV, intraoperative ischaemia, pericardial disruption, and suboptimal cardioprotection.…”

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

“…5 ) [ 43 , 44 ]. In addition to the significant effect of the pericardial incision, its extent also influences postoperative RV function along the long-axis; a less prominent decline was reported following minimally invasive surgical valve procedures than after full sternotomy [ 45 , 46 ]. These findings suggest that minimally invasive approaches tend to have a less deleterious effect on longitudinal RV function and that preservation of the pericardium might be beneficial.…”

Quantitative Transthoracic Echocardiography of the Response to Dobutamine in Cardiac Surgery Patients With Low Cardiac Output Syndrome

“…RV failure, defined by abnormal FAC, is a frequent phenomenon (»40%) in patients with hypotension 34 or LCOS signs 6 after several types of cardiac surgery and is associated with increased mortality. However, the prognostic value of postoperative impairment of RV longitudinal function has been questioned by several authors 35,36 because longitudinal impairment occurs on pericardial opening in the absence of intrinsic myocardial injury 37,38 and cardiac output is maintained 36 because of a compensatory increase in RV transverse function. 39 Little is known about the prognostic value of dobutamine in RV failure, and specific recommendations regarding postoperative LCOS patients are lacking.…”