Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2024 Aug;38(8):1673-1682. doi: 10.1053/j.jvca.2024.04.025. Epub 2024 Apr 22.
Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery.
Prospective study.
Tertiary care cardiac institute.
Cardiac surgical patients.
Cardiac surgery.
Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome.
Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them.
心脏手术中的右心室（RV）功能障碍可导致 RV 衰竭，从而增加发病率和死亡率。RV 功能异常可通过 RV 压力监测来识别。该研究的主要目的是确定在开始体外循环（CPB）分离前后，异常 RV 早期至舒张末期舒张压梯度（RVDPG）和异常 RV 舒张末期压（RVEDP）的患者比例。次要目的是评估 CPB 前的 RVDPG 是否与 CPB 分离困难和复杂、RV 功能障碍以及心脏手术后末期 RV 衰竭有关。
前瞻性研究。
三级心脏研究所。
心脏外科患者。
心脏手术。
自动电子量化 RVDPG 和 RVEDP。血流动力学测量与经食管超声心动图和术后并发症的心脏和心脏外参数相关。基线时 80%（n=105）的患者存在异常 RVDPG，平均 RVEDP 为 14.2±3.9mmHg。患者在 CPB 分离前 RVDPG>4mmHg 的时间中位数为 CPB 分离前术中时间的 50.2%，CPB 分离后为 60.6%。共有 46 名（43.8%）患者 CPB 分离困难/复杂，18 名（38.3%）患者 RV 功能障碍，8 名（17%）患者 RV 衰竭。CPB 前异常 RVDPG 与术后结局无关。
心脏手术中 RVDPG 和 RVEDP 升高很常见。CPB 前的 RVDPG 和 RVEDP 与 RV 功能障碍和衰竭无关，但可用于诊断它们。
