Marked reduction in right ventricular longitudinal contraction after cardiopulmonary bypass in patients with preserved right ventricular output

Abstract

Introduction Assessment of right ventricular (RV) function is crucial since RV failure with a reduced cardiac output is associated with compromised outcome in cardiac surgery. Echocardiographic evaluation of RV function is commonly used, and a reduction in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus tissue Doppler imaging (S’) have been observed independently of clinical signs of RV failure. This has led to uncertainty of these variables’ ability to reflect RV function in cardiac surgery [1]. The objective of this study was to describe changes in transoesophageal echocardiographic (TEE) measurements of TAPSE and S’ during coronary artery bypass graft (CABG) surgery with detailed haemodynamic monitoring using pulmonary artery catheter (PAC) assessment of RV output in patients undergoing uncomplicated CABG without RV impairment. Methods We prospectively studied 30 patients with concomitant PAC and TEE measurements at four time-points, namely after: anaesthesia induction, sternotomy, cardiopulmonary bypass (CPB) and upon arrival in the intensive care unit (ICU). Results TAPSE and S’ were significantly reduced by 43% (p Discussion TAPSE and S’ were both reduced after CPB despite maintained cardiac output. RVFAC, RVEF and RV-GLS remained stable, however, these measures were unable to detect minor changes in SV. 3D-echocardiography showed a strong correlation with SV measured by thermodilution, but with a consistent underestimation of approximately 10%. Our results suggest that 3D echocardiography is better at tracking RV output than other echocardiographic modalities, however, the clinician should be aware that 3D echocardiography underestimates SV compared to thermodilution.