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Table 4 Proposed definition of perioperative right ventricular failure in patients undergoing cardiac surgery

From: Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications

A. Intraoperative acute RVF

i) Difficult separation from CPB, characterized by either the following:

1

Concurrent use of ≥ 1 vasopressor and ≥ 1 inotrope and/or inhaled pulmonary vasodilator OR

2

Requiring > 1 CPB weaning attempt for RVF OR

3

Mechanical support device to facilitate wean (i.e. IABP or RVAD)

AND

ii) Anatomical visualization of impaired or absent RV wall motion by the following:

a

Direct intraoperative visual inspection* OR

b

 > 20% reduction in RVFAC measured by 2D echocardiography

OR

B. Postoperative acute RVF (haemodynamic criteria on arrival to ICU)

i

CVP > 15 mmHg or CI < 1.8 Lmin-1 m-2 AND

ii

Absence of elevate LAP and PCWP > 18 mmHg, tamponade, VT, or pneumothorax** AND

iii

RVSWI < 4 where RVSWI = 0.136 × SVI × (mPAP-RAP), and SVI = strove volume/BSA

  1. Adapted from Jabagi et al. (Jabagi et al. 2022)
  2. *Global hypokinesis or akinesis and/or severe RV dilatation/ballooning
  3. **Causing haemodynamic compromise or tension pneumothorax
  4. RVF right ventricular failure, CPB cardiopulmonary bypass, IABP intra-aortic balloon pump, RVAD right ventricular assist device, RVFAC right ventricular fractional area change, CVP central venous pressure, CI cardiac index, LAP left atrial pressure, PCWP pulmonary capillary wedge pressure, VT ventricular tachycardia, RVSWI RV stroke work index, SVI stroke volume index, mPAP mean pulmonary artery pressure, RAP right atrial pressure, SVI stroke volume index, BSA body surface area
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Perioperative Medicine

ISSN: 2047-0525