Table 3 Perioperative assessment and staging of RV function from A (low risk) to E (RV shock)
Stage | Description | Physical exam | Biomarkers | Hemodynamics | Imaging |
|---|---|---|---|---|---|
A Low risk | Fewer than two clinical or surgical risk factors but no signs or symptoms of RVD | Normal | Normal | Normal systemic blood pressure | Negative/not performed |
B At-risk | Greater than two clinical or surgical risk factors but no signs or symptoms of RVD | Normal | Elevated BNP | Normal systemic blood pressure Normal CVP | Negative/not performed |
C RVD | Imaging suggestive of RVD, but no evidence of end-organ dysfunction | Mild signs of RVD | Elevated BNP | Normal systemic blood pressure Normal CVP If known: Cardiac index ≥ 2.2 | RV dilation reduced TAPSE, FAC, RVEF |
D RVF | Evidence of end-organ dysfunction | Increased JVD, LE ascites Hepatomegaly Decreased UOP | Elevated BNP | Low systemic blood pressure requiring pharmacological interventions Cardiac index < 2.2 | RV dilation, reduced TAPSE, FAC, RVEF., TR, hepatic vein congestion |
E RV shock | Evidence of end-organ dysfunction unresponsive to pharmacologic intervention | Stage D criteria and altered MS, poor peripheral perfusion | Stage D criteria | Low systemic blood pressure refractory to maximal pharmacologic intervention and when mechanical circulatory support devices are in place or being considered | Stage D criteria |