Right ventricular diastolic dysfunction and postoperative cardiac complications in patients undergoing coronary artery bypass grafting

Abstract

Abstract Background Perioperative right ventricular (RV) dysfunction is associated with increased postoperative morbidity and mortality in patients undergoing heart surgery and large vessels. Almost all data on the importance of right ventricle function is specifically focused on its systolic dysfunction, which usually develops with severe left heart dysfunction. At the same time, the perioperative assessment of right ventricle filling during cardiac surgery has been far less studied. Purpose To evaluate whether the presence of preexisting RV diastolic dysfunction in patients undergoing coronary artery bypass grafting (CABG) is associated independently with higher incidents of postoperative cardiac complications. Design: one-center observational study. Methods The patient population consisted of those who underwent CABG in the cardiovascular surgery department from February 2017 to November 2018 (n=200, 153 males). Transthoracic echocardiography was performed on a Philips Clear Vue 550. Following RV systolic and diastolic parameters were studied: peak velocity of early (Et) and late (At) transtricuspid RV filling and their ratio. Tissue Doppler imaging was used to measure peak diastolic and systolic velocities at the tricuspid annulus (et', a't, s't), TAPSE, and RV Tei index. All patients were divided into 2 groups: with RV diastolic dysfunction (RVDD, n=92), and without RV diastolic dysfunction (control, n=108). Results Compared with those without RVDD, in patients with RVDD postoperative heart failure (HF, primary outcome) developed more frequently (p=0.026). The risk of developing postoperative HF was 3.39 in patients with RVDD compared with patients without RVDD (95% CI, 1.15–9.97; p=0.025). Left ventricular ejection fraction (LVEF) increase predicted a lower risk of postoperative HF with an OR = 0.95 (95% CI, 0.9–1.0; p=0.051). Female sex, cardiopulmonary bypass, increase of left ventricular mass index, and Et / At ratio also increased the risk of postoperative HF developing. But only RVDD, cardiopulmonary bypass and female sex were associated independently with development postoperative HF in the multivariate analyses. Conclusion Decreased preoperative RV diastolic function, cardiopulmonary bypass and female sex are independent risk factors for development postoperative HF after CABG in coronary artery disease patients. In contrast, LVEF and RV systolic dysfunction were not associated independently with this outcome. Therefore, assessment of preoperative RV diastolic function will be useful for predicting development postoperative HF following CABG. In addition, the Et / At ratio was the best echocardiographic marker associated with the postoperative HF development after CABG surgery. Funding Acknowledgement Type of funding sources: None.