Abstract
BackgroundRight Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04–1.0% of cardiac surgeries with cardiotomy and in 20–50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated.MethodsWe conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600).ResultsIn the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it.ConclusionThe protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.
Highlights
Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx)
The protocol development went through three major phases: systematic review, development, and validation
We highlight that Heart transplantations (HTx) anesthesiologists usually are a small homogenous group, thereby favoring implementations and enhancements over time
Summary
Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04–1.0% of cardiac surgeries with cardiotomy and in 20–50% of HTx, with mortality up to 75%. Heart transplantations (HTx) present many complications related to the anesthetic and surgical proceedings. Right Ventricular Dysfunction (RVD) is the most prevalent hemodynamic complication in the intraoperative and postoperative periods [1]. RVD occurs in up to 20–50% of cases [2]. RVD is one of the most severe complications to occur during the intraoperative period [3]. It’s a frequent complication following general heart surgeries, much more difficult to treat than left ventricular dysfunction [4]. Acute RVD after cardiac surgery is associated with mortality rates as high as 75% [5]
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