Pulmonary artery wave reflection and right ventricular function after lung resection

Glass, Amy Jocelyn; McCall, Philip; Arthur, Alex; Mangion, Kenneth; Shelley, Ben

doi:10.1016/j.bja.2022.07.052

Cited by 10 publications

(5 citation statements)

References 44 publications

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“…While lung resection is an effective clinical treatment for NSCLC, it is important to consider the close physiological and anatomical relationship between the lungs and the heart. Lung resection can lead to a decrease in the pulmonary vascular bed area, an increase in residual pulmonary blood flow, elevated pulmonary circulatory pressure, and increased right ventricular afterload ( 16 , 17 ). These factors can contribute to the development of right ventricular dysfunction, which progresses rapidly from compensation to decompensation in comparison to that in the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and prognostic analysis of right ventricular dysfunction after lung resection for NSCLC

Tan,

Tao,

Zhang

et al. 2024

Front. Oncol.

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ObjectivesLung cancer is the leading cause of cancer death, and 80–85% of all lung cancer cases are non-small cell lung cancer (NSCLC). Surgical resection is the standard treatment for early-stage NSCLC. However, lung resection, a surgical procedure, can result in complications and increased mortality. Recent studies have shown a significant correlation between complications after lung resection and right ventricular dysfunction.MethodsTransthoracic echocardiography-derived right ventricular-pulmonary artery coupling (RV-PAC) was utilized to assess right ventricular function in these patients. Multivariate logistic regression analysis was also conducted to assess risk factors independently associated with RV-PA uncoupling. The 3- and 5-year cumulative survival rates were estimated with Kaplan-Meier curves, and differences between groups were analyzed using the Mantel-Cox log-rank test.ResultsRV-PA uncoupling was defined as a TAPSE/PASP value < 0.67 mm/mm Hg according to spline analysis. The results of multivariable logistic regression analysis indicated that diabetes is an independent risk factor for right ventricular dysfunction after lung resection in patients with NSCLC. Kaplan-Meier analysis revealed a significant decrease in the survival rate of patients with RV-PA uncoupling at both the 3-year follow-up (73% vs 40%, p < 0.001) and 5-year follow-up (64% vs 37%, p < 0.001).ConclusionsAfter lung resection for NSCLC, the patient’s right ventricular function predicts prognosis. Patients with right ventricular dysfunction, particularly those with diabetes mellitus, have a worse prognosis. It is crucial to actively prevent and correct risk factors to reduce the mortality rate in these patients.

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Section: Discussionmentioning

confidence: 99%

Risk factors and prognostic analysis of right ventricular dysfunction after lung resection for NSCLC

Tan,

Tao,

Zhang

et al. 2024

Front. Oncol.

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“…This occurred because the weight and volume of the left lower lobe increased proportionally until 3 months after the surgery; however, after that, the hyperinflated state, during which only the volume increased, persisted. Surgical ligation of pulmonary artery branches increases afterload on the affected artery and leads to decreased blood flow ( 26 ). During LUL, which requires manipulation of multiple branches, it is particularly affected.…”

Section: Discussionmentioning

confidence: 99%

Relationship between pulmonary blood flow and volume following lung resection using dynamic perfusion digital radiography

Hanaoka,

Hayashi,

Shiratori

et al. 2023

J Thorac Dis

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Background Surgical intervention for lung resection can cause ventilation-perfusion mismatches and affect gas exchange; however, minimally invasive assessment of blood flow is difficult. This study aimed to evaluate changes in pulmonary blood flow after radical lung cancer surgery using a minimally invasive dynamic digital chest radiography system. Methods We evaluated 64 patients who underwent radical lobectomies. Postoperative changes in pulmonary blood flow, assessed using dynamic chest radiography-based blood flow ratios (BFRs), were compared with the temporal evolution of both functional lung volumes (FLVs) and estimated lung weight (ELW) derived from computed tomography (CT) volumetry. Results FLVs on the affected side gradually recovered over time from the lowest value observed 3 months after surgery in all procedures. BFRs on the affected side also showed a gradual recovery from the lowest value 1 month after surgery, except for left upper lobectomies (LULs). In LULs, FLVs and ELWs increased proportionally up to 3 months after surgery, with lung volumes continuing to increase thereafter. The recovery of BFRs differed depending on the resected lobe. Conclusions A relationship between pulmonary blood flow and FLV was observed in the postoperative period. Despite varying compensatory responses depending on the surgical procedure, FLV recovery coincided with increased pulmonary blood flow.

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“…Whilst intraoperatively pulmonary vascular resistance increases on institution of OLV and at pulmonary artery clamping, this acute increase returns to baseline postoperatively (Lewis et al 1994;Waller et al 1996), yet RV function remains depressed (McCall et al 2019). More recent work however has demonstrated profound changes in pulsatile afterload quantified in terms of pulse wave reflection and pulmonary artery compliance following lung resection which are persistent postoperatively and are associated with reduced RVEF (Glass et al 2023).…”

Section: Lung Resectionmentioning

confidence: 99%

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

Shelley,

McAreavey,

McCall

2024

Perioper Med

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In this edition of the journal, the Perioperative Quality Initiative (POQI) present three manuscripts describing the physiology, assessment, and management of right ventricular dysfunction (RVD) as pertains to the perioperative setting. This narrative review seeks to provide context for these manuscripts, discussing the epidemiology of perioperative RVD focussing on definition, risk factors, and clinical implications. Throughout the perioperative period, there are many potential risk factors/insults predisposing to perioperative RVD including pre-existing RVD, fluid overload, myocardial ischaemia, pulmonary embolism, lung injury, mechanical ventilation, hypoxia and hypercarbia, lung resection, medullary reaming and cement implantation, cardiac surgery, cardiopulmonary bypass, heart and lung transplantation, and left ventricular assist device implantation. There has however been little systematic attempt to quantify the incidence of perioperative RVD. What limited data exists has assessed perioperative RVD using echocardiography, cardiovascular magnetic resonance, and pulmonary artery catheterisation but is beset by challenges resulting from the inconsistencies in RVD definitions. Alongside differences in patient and surgical risk profile, this leads to wide variation in the incidence estimate. Data concerning the clinical implications of perioperative RVD is even more scarce, though there is evidence to suggest RVD is associated with atrial arrhythmias and prolonged length of critical care stay following thoracic surgery, increased need for inotropic support in revision orthopaedic surgery, and increased critical care requirement and mortality following cardiac surgery. Acute manifestations of RVD result from low cardiac output or systemic venous congestion, which are non-specific to the diagnosis of RVD. As such, RVD is easily overlooked, and the relative contribution of RV dysfunction to postoperative morbidity is likely to be underestimated.We applaud the POQI group for highlighting this important condition. There is undoubtedly a need for further study of the RV in the perioperative period in addition to solutions for perioperative risk prediction and management strategies. There is much to understand, study, and trial in this area, but importantly for our patients, we are increasingly recognising the importance of these uncertainties.

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Pulmonary artery wave reflection and right ventricular function after lung resection

Cited by 10 publications

References 44 publications

Risk factors and prognostic analysis of right ventricular dysfunction after lung resection for NSCLC

Risk factors and prognostic analysis of right ventricular dysfunction after lung resection for NSCLC

Relationship between pulmonary blood flow and volume following lung resection using dynamic perfusion digital radiography

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

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