Table 3 Summary of selected studies describing post-operative changes in right ventricular function and their clinical significance in patients undergoing cardiac surgery
From: Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications
Study | Surgical population | N | Age Proportion male (%) | Method of assessment | Definition of RVD | Incidence of postoperative RVD | Clinical significance/comments |
|---|---|---|---|---|---|---|---|
Reichert et al. (1992) | Cardiac surgery — mixed | 52 | Not stated | Clinical and echo | Hypotension (< 65 mmHg) despite inotropes + / − IABP and RVFAC < 35% | Evidence of RVF in 18 (34.6%) • 9 (17.3%) were biventricular failure • 9 (17.3%) isolated RVF | Mortality 81.8% in biventricular failure and 90% in isolated RVF |
Maslow et al. (2002) | Cardiac surgery — CABG with severe LVSD (LVEF < 25%) | 41 | 61.4, 56.3–66.5 85.4% | Echo | RVFAC < 35% | 7 (17.1%) | Associated with early (30 days) mortality (71% vs 0) and prolonged duration of mechanical ventilation and both ICU and hospital stay |
Moazami et al. (2004) | Cardiac surgery — mixed | 9270 | 58 (15) 13 (43.3%) | Clinical | Need for RVAD | 30 (0.3%) need for RVAD | Mortality 66.6%. Excluded medically managed RVF |
Schuuring et al. (2013) | Cardiac surgery — congenital heart disease | 412 | 36, 18–74 56% | Clinical and echo | ‘Elevated jugular venous pressure’, impaired RV function on echo and a diagnosis of RV failure documented in the medical charts | 4.4% | Mortality of 33.3% in RV failure group vs 2.3% in non-RV failure group (p < 0.01) Impaired pre-op RV function, SVT and CPB time associated with post-op RV failure |
Denault et al. (2016) | Cardiac surgery — high risk with pulmonary hypertension | 124 | 68.3 (9.2)A 70.2 (10.2)A 48.4% | Clinical and echo | Hemodynamic instability, defined as difficult or complex separation from CPB, 20% reduction in RVFAC, and visualisation of impaired or absent RV wall motion | 18 (14.5%) | Mortality 22% in RVF group vs 2% in no RVF (p < 0.001) |
Cardiac surgery — mixed | 1109 | 74 [67-79]A 70 [63-77]A 66 [58-73]A 64.8% | PAC | RVEF < 20% within first 24 h | 216 (19.5%) | RVF associated with 2-year mortality — 16.7% vs 8.2% vs 4.1% in those with RVEF < 20%, 20–30% and > 30% respectively (p < 0.001). RVEF associated with ICU LOS, duration of mechanical ventilation, and increased creatinine | |
Levy et al. (2021) | Cardiac surgery — mixed | 3826 | 68.6 (10.9) 74.5% | Clinical and echo | Hemodynamic instability requiring vasoactive support and immediate post-op pulmonary vasodilators with echo evidence of RVF; RV free wall hypokinesia or IVS flattening or RV dilatation (RV/LV ratio > 1) | 110 (2.9%) | No difference in mortality (1.8% vs 0.7%). RVF associated with post-op AF and ICU LOS |