Right Ventricular Depression After Cardiopulmonary Bypass for Valvular Surgery

Denault, André; Couture, Pierre; Beaulieu, Yanick; Haddad, François; Deschamps, Alain; Nozza, Anna; Pagé, Pierre; Tardif, Jean‐Claude; Lambert, Jean

doi:10.1053/j.jvca.2015.01.011

Cited by 41 publications

(28 citation statements)

References 37 publications

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“…The evaluation of RV function is an important procedure in patients undergoing cardiac surgery, not only preoperatively 33 but also in the early postoperative period. 6,7 In the present study, the incidence of postoperative RV longitudinal dysfunction was greater in the LCOS group. Furthermore, acute dobutamine therapy induced a moderate recovery (»18%), in agreement with measures of global performance and tissue perfusion.…”

Section: Discussionsupporting

confidence: 45%

“…undergoing coronary artery bypass graft (CABG) or valvular surgical procedures. 2,3,5 Other contributing mechanisms include right ventricular (RV) dysfunction 6,7 and LV diastolic abnormalities. 8 However, the relative contribution of these mechanisms is unknown, and no studies to date have assessed the ability of standard echocardiographic thresholds to identify LCOS patients.…”

mentioning

confidence: 99%

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

Zarragoikoetxea

Vicente

Pajares

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionsupporting

confidence: 45%

mentioning

confidence: 99%

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

Zarragoikoetxea

Vicente

Pajares

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…We have previously shown that hemodynamic instability after CPB is often the result of various mechanisms. 52 For instance, vasoplegia might not respond well to iMil; however, in patients undergoing coronary revascularization 33 and valvular and complex surgery, 32 RV dysfunction is almost invariably present after CPB. In this study, RV failure was present in more than one-third (13/36) of those patients with difficult or complex separation from CPB.…”

Section: Discussionmentioning

confidence: 99%

“…A decrease in mean arterial pressure (MAP) \ 60 mmHg was treated by fluid administration (in the presence of a low CVP) or by the use of vasopressors (noradrenaline or phenylephrine) according to a predetermined protocol, as previously described. 31,32 During CPB (CPB flow = 2.2 LÁmin -1 Ám -2 ), blood cardioplegia was used in all patients. Induction and maintenance of cardioplegia were cold to tepid (10-29°C).…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Denault

Bussières

Arellano

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Inhaled milrinone (iMil) has been used for the treatment of pulmonary hypertension (PH) but its efficacy, safety, and prophylactic effects in facilitating separation from cardiopulmonary bypass (CPB) and preventing right ventricular (RV) dysfunction have not yet been evaluated in a clinical trial. The purpose of this study was to investigate if iMil administered before CPB would be superior to placebo in facilitating separation from CPB.Methods High-risk cardiac surgical patients with PH were randomized to receive iMil or placebo after the induction of anesthesia and before CPB. Hemodynamic parameters and RV function were evaluated by means of pulmonary artery catheterization and transesophageal echocardiography. The groups were compared for the primary outcome of the level of difficulty in weaning from CPB. Among the secondary outcomes examined were the reduction in the severity of PH, the incidence of RV failure, and mortality. Results Of the 124 patients randomized, the mean (standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The use of iMil was associated with increases in cardiac output (P = 0.03) and a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless, there was no difference in the combined incidence of difficult or complex separation from CPB between the iMil and control groups (30% vs 28%, respectively; absolute difference, 2%; 95% confidence interval [CI], -14 to 18; P = 0.78). There was also no difference in RV failure between the iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI, -13 to 12; P = 0.94). Mortality was increased in patients with RV failure vs those without (22% vs 2%, respectively; P \ 0.001). Conclusion In high-risk cardiac surgery patients with PH, the prophylactic use of iMil was associated with favourable hemodynamic effects that did not translate into improvement of clinically relevant endpoints. This trial was registered at ClinicalTrials.gov; identifier: NCT00819377. RésuméObjectif La milrinone inhalée est utilisée pour traiter l'hypertension pulmonaire (HP) mais son efficacité, son innocuité et ses effets prophylactiques pour faciliter le sevrage de la circulation extracorporelle (CEC) et prévenir la dysfonction ventriculaire droite (VD) n'ont pas encore été évalués dans le cadre d'une étude clinique. L'objectif de cette étude était d'examiner si la milrinone inhalée avant la CEC serait supérieure à un placebo pour faciliter le sevrage de la CEC. Méthode Des patients de chirurgie cardiaque à risque élevé et souffrant d'HP ont été randomisés à recevoir de la milrinone inhalée ou un placebo après l'induction de l'anesthésie et avant la CEC. Les paramètres hémodynamiques et la fonction VD ont été évalués à l'aide d'un cathéter de l'artère pulmonaire et d'une échocardiographie transoesophagienne. Les groupes ont été comparés selon notre critère d'évaluation principal, soit le niveau de difficulté du sevrage de la CEC. Parmi les critères...

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“…This is particularly important in cardiac surgery patients in whom numerous insults to the right ventricle occur over time (eg, poor preservation with cardioplegia, air, increased pulmonary vascular resistance after CPB), and RV function must be reassessed continually during the prebypass and postbypass periods. 26,27 It is important to note that even though the authors of the present study found both regional and global strain measurements to be highly sensitive for RV dysfunction, the specificity was only moderate. Consequently, a normal RV strain measurement likely rules out dysfunction but an abnormal RV strain sometimes is seen in the setting of a normal RV EF.…”

Section: Discussionmentioning

confidence: 48%

Regional Versus Global Measurements of Right Ventricular Strain Performed in the Operating Room With Transesophageal Echocardiography

Silverton

Lee

Morrissey

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Right Ventricular Depression After Cardiopulmonary Bypass for Valvular Surgery

Cited by 41 publications

References 37 publications

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

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

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Regional Versus Global Measurements of Right Ventricular Strain Performed in the Operating Room With Transesophageal Echocardiography

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