Right Ventricular Function in Surgical Treatment of Left Heart

Aim    The aim of this study was to evaluate right ventricular (RV) function during left chamber surgery.
Material and methods    This was a single-site prospective cohort study. The study included 197 patients with valvular pathology of heart left chambers. Mean age of patients was 58 [47; 65] years. Precordial echocardiography was performed preoperatively and within one week after surgery.
Results    Decreased parameters of the right ventricular (RV) longitudinal function and global contractile function were observed postoperatively in the majority of patients. More noticeable decreases were observed in parameters of the longitudinal function (p<0.001). Analysis of the changes in RV contractility depending on the underlying pathology revealed the greatest changes in the contractile function in the mitral insufficiency group. In the mitral stenosis group, the greatest difference was observed in the tricuspid annular systolic excursion (TAPSE) (p=0.027). In the groups with aortic defects, all parameters of RV contractile function, except for the fractional area change (FAC), showed statistically significant decreases after correction of the underlying defect (p<0.05).
Conclusions    Surgical intervention for left heart valvulopathy can result in a decrease in RV function unrelated with systolic deficit of the left ventricle. Modern technologies allow multi-vector assessment of the RV contractile function. To assess the RV function, it is advisable to use a combination of parameters that reflect both global and longitudinal function.

1. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A et al. Updated Clinical Classification of Pulmonary Hypertension. Journal of the American College of Cardiology. 2013;62(25):D34–41. DOI: 10.1016/j.jacc.2013.10.029

2. Le Tourneau T, Deswarte G, Lamblin N, Foucher-Hossein C, Fayad G, Richardson M et al. Right Ventricular Systolic Function in Organic Mitral Regurgitation: Impact of Biventricular Impairment. Circulation. 2013;127(15):1597–608. DOI: 10.1161/CIRCULATIONAHA.112.000999

3. Hyllén S, Nozohoor S, Ingvarsson A, Meurling C, Wierup P, Sjögren J. Right Ventricular Performance After Valve Repair for Chronic Degenerative Mitral Regurgitation. The Annals of Thoracic Surgery. 2014;98(6):2023–30. DOI: 10.1016/j.athoracsur.2014.07.075

4. Amsallem M, Mercier O, Kobayashi Y, Moneghetti K, Haddad F. Forgotten No More: A Focused Update on the Right Ventricle in Cardiovascular Disease. JACC: Heart Failure. 2018;6(11):891–903. DOI: 10.1016/j.jchf.2018.05.022

5. Alam M, Hedman A, Nordlander R, Samad B. Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus. American Heart Journal. 2003;146(3):520–6. DOI: 10.1016/S0002-8703(03)00313-2

6. Rong LQ, Yum B, Abouzeid C, Palumbo MC, Brouwer LR, Devereux RB et al. Echocardiographic predictors of intraoperative right ventricular dysfunction: a 2D and speckle tracking echocardiography study. Cardiovascular Ultrasound. 2019;17(1):11. DOI: 10.1186/s12947-019-0161-3

7. Tamborini G, Muratori M, Brusoni D, Celeste F, Maffessanti F, Caiani EG et al. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. European Journal of Echocardiography. 2009;10(5):630–4. DOI: 10.1093/ejechocard/jep015

8. Van Orman JR, Connelly K, Albinmousa Z, Tousignant C. Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery – an observational study. Canadian Journal of Anesthesia. 2016;63(8):920–7. DOI: 10.1007/s12630-016-0651-9

9. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003

10. Avdeev S.N., Aldashev A.A., Gorbachevskiy S.V., Edemskiy A.G., Karaskov A.M., Korobkova I.Z. et al. Pulmonary Hypertension. - M.: GEOTAR-Media;2015. - 416 p. ISBN 978-5-9704-3323-2

11. Maffessanti F, Gripari P, Tamborini G, Muratori M, Fusini L, Alamanni F et al. Evaluation of Right Ventricular Systolic Function after Mitral Valve Repair: A Two-Dimensional Doppler, Speckle-Tracking, and Three-Dimensional Echocardiographic Study. Journal of the American Society of Echocardiography. 2012;25(7):701–8. DOI: 10.1016/j.echo.2012.03.017

12. Khani M, Hosseintash M, Foroughi M, Naderian M, Khaheshi I. Assessment of the effect of off-pump coronary artery bypass (OPCAB) surgery on right ventricle function using strain and strain rate imaging. Cardiovascular Diagnosis and Therapy. 2016;6(2):138–43. DOI: 10.21037/cdt.2016.02.03

13. Haddad F, Couture P, Tousignant C, Denault AY. The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: II. Pathophysiology, Clinical Importance, and Management. Anesthesia & Analgesia. 2009;108(2):422–33. DOI: 10.1213/ane.0b013e31818d8b92

14. Unsworth B, Casula RP, Kyriacou AA, Yadav H, Chukwuemeka A, Cherian A et al. The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision. American Heart Journal. 2010;159(2):314–22. DOI: 10.1016/j.ahj.2009.11.013

15. Vitel E, Galli E, Leclercq C, Fournet M, Bosseau C, Corbineau H et al. Right ventricular exercise contractile reserve and outcomes after early surgery for primary mitral regurgitation. Heart. 2018;104(10):855–60. DOI: 10.1136/heartjnl-2017-312097

16. Unsworth B, Casula RP, Yadav H, Baruah R, Hughes AD, Mayet J et al. Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation of post-operative values. International Journal of Cardiology. 2013;165(1):151–60. DOI: 10.1016/j.ijcard.2011.08.031

17. Onorati F, Santarpino G, Marturano D, Rubino AS, Pasceri E, Zinzi S et al. Successful surgical treatment of chronic ischemic mitral regurgitation achieves left ventricular reverse remodeling but does not affect right ventricular function. The Journal of Thoracic and Cardiovascular Surgery. 2009;138(2):341–51. DOI: 10.1016/j.jtcvs.2008.12.034

18. Orde SR, Chung S-Y, Pulido JN, Suri RM, Stulak JM, Oh JK et al. Changes in Right Ventricle Function After Mitral Valve Repair Surgery. Heart, Lung and Circulation. 2020;29(5):785–92. DOI: 10.1016/j.hlc.2019.06.724

19. Bootsma IT, De Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T et al. Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(5):1656–62. DOI: 10.1053/j.jvca.2017.02.008

20. Tokodi M, Németh E, Lakatos BK, Kispál E, Tősér Z, Staub L et al. Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction? ESC Heart Failure. 2020;7(3):1246–56. DOI: 10.1002/ehf2.12682

21. Denault AY, Pearl RG, Michler RE, Rao V, Tsui SSL, Seitelber ger R et al. Tezosentan and Right Ventricular Failure in Patients With Pulmonary Hypertension Undergoing Cardiac Surgery: The TACTICS Trial. Journal of Cardiothoracic and Vascular Anesthesia. 2013;27(6):1212–7. DOI: 10.1053/j.jvca.2013.01.023

22. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK et al. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018;137(20):e578–622. DOI: 10.1161/CIR.0000000000000560

23. Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME. Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesthesia and Analgesia. 2002;95(6):1507–18. DOI: 10.1097/00000539-200212000-00009

24. Del Rio JM, Grecu L, Nicoara A. Right Ventricular Function in Left Heart Disease. Seminars in Cardiothoracic and Vascular Anesthesia. 2019;23(1):88–107. DOI: 10.1177/1089253218799345

25. Singh A, Huang X, Dai L, Wyler D, Alfirevic A, Blackstone EH et al. Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy. The Journal of Thoracic and Cardiovascular Surgery. 2020;159(4):1430-1438.e4. DOI: 10.1016/j.jtcvs.2019.04.035

26. Bootsma IT, Scheeren TWL, De Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. Journal of Cardiothoracic and Vascular Anesthesia. 2020;34(8):2140–7. DOI: 10.1053/j.jvca.2020.01.012

27. Antevil JL, Napolitano MA, Mordini FE, McCarthy PM, Trachiotis GD. The Right Ventricle in the Trans-Catheter Era: A Perspective for Planning Interventions. Seminars in Thoracic and Cardiovascular Surgery. 2022;34(3):892–901. DOI: 10.1053/j.semtcvs.2021.07.030

28. Mandoli GE, Cameli M, Novo G, Agricola E, Righini FM, Santoro C et al. Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography. Heart Failure Reviews. 2019;24(5):625–35. DOI: 10.1007/s10741-019-09785-2

29. Okada DR, Rahmouni HW, Herrmann HC, Bavaria JE, Forfia PR, Han Y. Assessment of Right Ventricular Function by Transthoracic Echocardiography Following Aortic Valve Replacement. Echocardiography. 2014;31(5):552–7. DOI: 10.1111/echo.12421