Preexisting right ventricular systolic dysfunction in high-risk patients undergoing non-emergent open abdominal surgery

Abstract

Background: The prognostic value of right ventricular systolic dysfunction in high-risk patients undergoing non-emergent open abdominal surgery is unknown. Here, we aim to evaluate whether presence of preexisting right ventricular systolic dysfunction in this surgical cohort is independently associated with higher incidence of postoperative major adverse cardiac events and all-cause in-hospital mortality. Methods: This is a single-centered retrospective study. Patients identified as American Society Anesthesiology Classification III and IV who had a preoperative echocardiogram within 1 year of undergoing non-emergent open abdominal surgery between January 2010 and May 2017 were included in the study. Incidence of postoperative major cardiac adverse events and all-cause in-hospital mortality were collected. Multivariable logistic regression was performed in a step-wise manner to identify independent association between preexisting right ventricular systolic dysfunction with outcomes of interest. Results: Preexisting right ventricular systolic dysfunction was not associated with postoperative major adverse cardiac events ( P = 0.26). However, there was a strong association between preexisting right ventricular systolic dysfunction and all-cause in-hospital mortality ( P = 0.00094). After multivariate analysis, preexisting right ventricular systolic dysfunction continued to be an independent risk factor for all-cause in-hospital mortality with an odds ratio of 18.9 (95% CI: 1.8-201.7; P = 0.015). Conclusion: In this retrospective study of high-risk patients undergoing non-emergent open abdominal surgery, preexisting right ventricular systolic dysfunction was found to have a strong association with all-cause in-hospital mortality.

Clinical implications of preoperative echocardiographic findings on cardiovascular outcomes following vascular surgery: An observational trial

“…Due to the small number of dialysis outcomes, we were unable to adjust to any other differences in RV function groups. Still, this finding is pathophysiologically plausible as RV failure can cause a reduction in cardiac output resulting in decreased renal blood flow [ 24 ] and increased venous congestion [ 25 ] but is inconsistent with a prior small cohort study demonstrating an association between RV dysfunction and mortality, but not with dialysis [ 26 ]. However, even though RV dysfunction has been prospectively predictive of mortality in patients with chronic kidney disease [ 27 ], research into the relationship between pulmonary hypertension, RV dysfunction and chronic kidney disease is in its infancy [ 28 ].…”

Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications

“…Outside of the cardiac surgical setting, the prevalence of pre-existing RVD in surgical populations has seen limited study; however, what data does exist (Table 1) suggests a prevalence of anywhere between 5.7 and 100% and a profound effect on clinical outcomes. Prevalence figures naturally vary depending on patient population and definition of RVD -in the majority of studies, RVD is defined as 'normal' versus 'abnormal' on the basis of visual inspection on echocardiography images resulting in a relatively consistent estimate of the prevalence in the region of 5.7-11% (Chou et al 2021;Chou et al 2019;Joseph et al 2021;Meyer et al 2023). Reflecting an extreme estimate of incidence, Kim et al however examined RV function in 78 patients with mean age of 80.1 (9.1) years who had sustained a fractured hip and observed that RVD as defined by abnormal RV global longitudinal strain on 2D-speckle tracking was present in all (100%) patients (Kim et al 2017).…”

“…Reflecting an extreme estimate of incidence, Kim et al however examined RV function in 78 patients with mean age of 80.1 (9.1) years who had sustained a fractured hip and observed that RVD as defined by abnormal RV global longitudinal strain on 2D-speckle tracking was present in all (100%) patients (Kim et al 2017). Both pre-existing RVD and RV dilatation have been associated with increased incidence of complications and/or mortality in patients undergoing vascular, abdominal, orthopaedic, and renal transplant surgery (Chou et al 2021;Chou et al 2019;Joseph et al 2021;Kim et al 2017) (Table 1).…”