Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany.
J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1628-1637. doi: 10.1053/j.jvca.2021.01.026. Epub 2021 Jan 18.
Few data exist on perioperative three-dimensional-derived right ventricular strain. The authors aimed to describe the perioperative course of three-dimensional-derived right ventricular strain in coronary artery bypass graft (CABG) surgery patients.
Prospective, observational, pilot trial.
Single university hospital.
The study comprised 40 patients with preserved left ventricular and right ventricular (RV) function undergoing isolated on-pump CABG surgery.
Three-dimensional strain analysis and standard echocardiographic evaluation of RV function were performed preoperatively (T1) and postoperatively (T4) with transthoracic echocardiography (TTE) and intraoperatively before sternotomy (T2) and after sternotomy (T3) with transesophageal echocardiography (TEE). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support.
The measurements of three-dimensional-derived RV free-wall strain (3D-RV FWS) and RV ejection fraction were performed using TomTec 4D RV-Function 2.0 software. Philips QLAB 10.8 was used to analyze tissue velocity of the tricuspid annulus, tricuspid annular systolic excursion, and RV fractional area change. There were no significant differences (median [interquartile range {IQR}]) between preoperative TTE and intraoperative TEE measurements for 3D-RV FWS (T1 v T2: -22.35 [IQR -17.70 to -27.22] v -24.35 [IQR -20.63 to -29.88]; not significant). 3D-RV FWS remained unchanged after sternotomy (T2 v T3: -24.35 [IQR -20.63 to -29.88] v -23.75 [IQR -20.25 to -29.28]; not significant) but deteriorated significantly after CABG (T1 v T4: -22.35 [IQR -17.70 to -27.22] v -18.5 [IQR -16.90 to -21.65]; p = 0.004).
In patients undergoing on-pump CABG, 3D-RV FWS values for awake, spontaneously breathing patients measured with TTE and values assessed in patients under general anesthesia with TEE did not significantly differ. Three-dimensional RV FWS did not change after sternotomy but deteriorated after on-pump CABG.
关于围术期三维右心室应变的相关数据较为缺乏。本研究旨在描述体外循环冠状动脉旁路移植术（CABG）患者围术期三维右心室应变的变化过程。
前瞻性、观察性、初步试验。
单所大学医院。
本研究纳入了 40 例左心室和右心室（RV）功能正常的患者，这些患者拟行单纯体外循环 CABG 手术。
在体外循环前（T1）和术后（T4），通过经胸超声心动图（TTE）进行三维应变分析和 RV 功能的标准超声心动图评估，在体外循环前（T2）和体外循环后（T3）通过经食管超声心动图（TEE）进行。所有超声心动图测量均在稳定的血流动力学条件下，且在没有任何血管活性药物支持的情况下进行预定义的液体管理下进行。
使用 TomTec 4D RV-Function 2.0 软件进行三维右心室游离壁应变（3D-RV FWS）和 RV 射血分数的测量。使用 Philips QLAB 10.8 分析三尖瓣环组织速度、三尖瓣环收缩期位移和 RV 面积分数变化。术前 TTE 与术中 TEE 测量的 3D-RV FWS 之间无显著差异（中位数[四分位数间距 {IQR}]{median [interquartile range {IQR}]}）（T1 v T2：-22.35 [IQR -17.70 至 -27.22] v -24.35 [IQR -20.63 至 -29.88]；无显著差异）。体外循环后三尖瓣环无明显变化（T2 v T3：-24.35 [IQR -20.63 至 -29.88] v -23.75 [IQR -20.25 至 -29.28]；无显著差异），但 CABG 后明显恶化（T1 v T4：-22.35 [IQR -17.70 至 -27.22] v -18.5 [IQR -16.90 至 -21.65]；p=0.004）。
在接受体外循环 CABG 的患者中，TTE 测量的清醒、自主呼吸患者的三维 RV FWS 值与 TEE 评估的全麻患者的三维 RV FWS 值无显著差异。体外循环后三尖瓣环无明显变化，但体外循环后 CABG 后恶化。
