Denault André Y, Couture Pierre, Beaulieu Yanick, Haddad Francois, Deschamps Alain, Nozza Anna, Pagé Pierre, Tardif Jean-Claude, Lambert Jean
Departments of Anesthesiology; Division of Critical Care, Centre Hospitalier de l'Université de Montréaland Montreal Heart Institute.
Departments of Anesthesiology.
J Cardiothorac Vasc Anesth. 2015 Aug;29(4):836-44. doi: 10.1053/j.jvca.2015.01.011. Epub 2015 Jan 8.
To assess if right ventricular (RV) dysfunction is associated with increased mortality after cardiac surgery.
Post-hoc analysis of a single-center double-blind randomized controlled trial.
University hospital.
A total of 120 patients undergoing simple or complex valvular surgery.
Patients were randomized to receive intravenous amiodarone or placebo intraoperatively. As secondary analysis, patients were divided into those requiring or not requiring postoperative inotropic agents.
After cardiopulmonary bypass (CPB), there were significant increases in heart rate, cardiac index, systolic and mean arterial pressures, central venous pressure and pulmonary capillary wedge pressure with reduction in systemic vascular resistance (p<0.05). Right ventricular end-systolic area became larger in those without inotropes and tricuspid annular plane systolic excursion was reduced in all patients; mitral annular systolic velocities were higher in patients receiving inotropes. Both right- and left-sided Doppler signals were altered significantly after CPB, which may be attributed to increased filling pressure. Inotropic agents were required in 56 patients after CPB (47%). The use of inotropic agents was associated with increased left and right atrial velocities (p<0.05). There were no differences in postoperative complications between groups; however, the number of deaths at 6 years was increased in patients who received inotropes after CPB (p = 0.0247).
The increases in right-sided dimensions after CPB are associated with reduction in RV function and increased biventricular filling pressure, suggesting worsening biventricular function and interventricular dependence. Inotropic medications were associated with unaltered RV dimensions and increased biatrial activity.
评估心脏手术后右心室功能障碍是否与死亡率增加相关。
单中心双盲随机对照试验的事后分析。
大学医院。
共120例行简单或复杂瓣膜手术的患者。
患者术中随机接受静脉注射胺碘酮或安慰剂。作为次要分析，将患者分为术后需要或不需要使用正性肌力药物的两组。
体外循环（CPB）后，心率、心脏指数、收缩压和平均动脉压、中心静脉压及肺毛细血管楔压显著升高，而全身血管阻力降低（p<0.05）。未使用正性肌力药物的患者右心室收缩末期面积增大，所有患者的三尖瓣环平面收缩期位移减小；接受正性肌力药物治疗的患者二尖瓣环收缩速度较高。CPB后左右两侧的多普勒信号均发生显著改变，这可能归因于充盈压升高。CPB后56例患者（47%）需要使用正性肌力药物。使用正性肌力药物与左右心房速度增加相关（p<0.05）。两组术后并发症无差异；然而，CPB后接受正性肌力药物治疗的患者6年时的死亡人数增加（p = 0.0247）。
CPB后右侧维度的增加与右心室功能降低及双心室充盈压升高相关，提示双心室功能恶化和心室间依赖性增加。正性肌力药物与右心室维度未改变及双心房活动增加相关。
