Department of Cardiothoracic Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2020 Aug;34(8):2116-2125. doi: 10.1053/j.jvca.2019.12.042. Epub 2020 Jan 8.
Right ventricular (RV) dysfunction in cardiac surgery is associated with increased mortality and morbidity and difficult separation from cardiopulmonary bypass (DSB). The primary objective of the present study was to describe the prevalence and characteristics of patients with abnormal RV diastolic pressure gradient (PG). The secondary objective was to explore the association among abnormal diastolic PG and DSB, postoperative complications, high central venous pressure (CVP), and high RV end-diastolic pressure (RVEDP).
Retrospective and prospective validation study.
Tertiary care cardiac institute.
Cardiac surgical patients (n=374) from a retrospective analysis (n=259) and a prospective validation group (n=115).
RV pressure waveforms were obtained using a pulmonary artery catheter with a pacing port opened at 19 cm distal to the tip of the catheter. Abnormal RV diastolic PG was defined as >4 mmHg. Both elevated RVEDP and high CVP were defined as >16 mmHg.
From the retrospective and validation cohorts, 42.5% and 48% of the patients had abnormal RV diastolic PG before cardiac surgery, respectively. Abnormal RV diastolic PG before cardiac surgery was associated with higher EuroSCORE II (odds ratio 2.29 [1.10-4.80] v 1.62 [1.10-3.04]; p = 0.041), abnormal hepatic venous flow (45% v 29%; p = 0.038), higher body mass index (28.9 [25.5-32.5] v 27.0 [24.9-30.5]; p = 0.022), pulmonary hypertension (48% v 37%; p = 0.005), and more frequent DSB (32% v 19%; p = 0.023). However, RV diastolic PG was not an independent predictor of DSB, whereas RVEDP (odds ratio 1.67 [1.09-2.55]; p = 0.018) was independently associated with DSB. In addition, RV pressure monitoring indices were superior to CVP in predicting DSB.
Abnormal RV diastolic PG is common before cardiac surgery and is associated with a higher proportion of known preoperative risk factors. However, an abnormal RV diastolic PG gradient is not an independent predictor of DSB in contrast to RVEDP.
心脏手术中的右心室（RV）功能障碍与死亡率和发病率增加以及难以脱离心肺旁路（DSB）有关。本研究的主要目的是描述 RV 舒张期压力梯度（PG）异常患者的患病率和特征。次要目的是探讨异常舒张 PG 与 DSB、术后并发症、高中心静脉压（CVP）和高 RV 舒张末期压（RVEDP）之间的关联。
回顾性和前瞻性验证研究。
三级心脏研究所。
来自回顾性分析（n=259）和前瞻性验证组（n=115）的心脏外科患者。
使用肺动脉导管获得 RV 压力波形，导管尖端远端 19 厘米处打开起搏端口。异常 RV 舒张 PG 定义为>4mmHg。RVEDP 和 CVP 升高均定义为>16mmHg。
回顾性和验证队列中，分别有 42.5%和 48%的患者在心脏手术前存在 RV 舒张期 PG 异常。心脏手术前异常 RV 舒张 PG 与更高的 EuroSCORE II（比值比 2.29[1.10-4.80]与 1.62[1.10-3.04]；p=0.041）、异常肝静脉血流（45%比 29%；p=0.038）、更高的体重指数（28.9[25.5-32.5]与 27.0[24.9-30.5]；p=0.022）、肺动脉高压（48%比 37%；p=0.005）和更频繁的 DSB（32%比 19%；p=0.023）相关。然而，RV 舒张 PG 不是 DSB 的独立预测因子，而 RVEDP（比值比 1.67[1.09-2.55]；p=0.018）与 DSB 独立相关。此外，RV 压力监测指标优于 CVP 预测 DSB。
心脏手术前 RV 舒张 PG 异常很常见，与更多已知的术前危险因素有关。然而，与 RVEDP 相比，异常 RV 舒张 PG 梯度不是 DSB 的独立预测因子。
