This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Maslow, A. D. Articles by Comunale, M. E. Search for Related Content PubMed PubMed Citation Articles by Maslow, A. D. Articles by Comunale, M. E. Related Collections Cardiovascular Heart Monitoring (Cardiac)

---

CARDIOVASCULAR ANESTHESIA

Precardiopulmonary Bypass Right Ventricular Function Is Associated with Poor Outcome After Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Systolic Dysfunction

Andrew D. Maslow, MD^*, Meredith M. Regan, ScD, Peter Panzica, MD, Stephanie Heindel, MD, John Mashikian, MD, and Mark E. Comunale, MD

*Department of Anesthesiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island; and Beth Israel Deaconess Medical Center, Boston, Massachusetts

Address correspondence and reprint requests to Andrew Maslow, MD, Department of Anesthesiology, Rhode Island Hospital, Davol 129, 593 Eddy St., Providence RI 02903. Address e-mail to amaslow{at}lifespan.org

Patients with severe left ventricular systolic dysfunction (LVSD) undergoing coronary artery bypass grafting (CABG) have an increased risk for morbidity and mortality. The purpose of this study was to assess the association of pre-CABG right ventricular (RV) function with outcome for patients with severe LVSD. We performed a retrospective evaluation of 41 patients with severe LVSD (left ventricular ejection fraction [LVEF] 25%) scheduled for nonemergent CABG. Data were obtained from review of medical records, transesophageal echocardiography tapes, and phone interview. The pre- and post-cardiopulmonary bypass (CPB) LVEF and the RV fractional area of contraction (RVFAC) were calculated by using intraoperative transesophageal echocardiography. Group 1 patients had an RVFAC 35% (n = 7), whereas Group 2 patients had RVFAC >35% (n = 34). The durations of mechanical ventilation and of intensive care unit and hospital stays are presented as the median. Pre-CABG LVEF was similar between Groups 1 and 2 (15.8% ± 3.3% versus 17.8% ± 3.9%). Compared with Group 2, Group 1 patients required greater duration of mechanical ventilation (12 days versus 1 day; P < 0.01), longer intensive care unit (14 versus 2 days; P < 0.01) and hospital (14 versus 7 days; P = 0.02) stays, had a more frequent incidence and severity of LV diastolic dysfunction, and had a smaller change in LVEF immediately after CPB (4.1% ± 8.3% versus 12.5% ± 9.2%; P = 0.03). All Group 1 patients died of cardiac causes within 2 yr of surgery; five died during the same hospital admission. Three Group 2 patients died: one of colon cancer at 18 mo after CABG and two of cardiac causes 24 and 48 mo after surgery. A fourth patient was awaiting cardiac transplantation 4 yr after surgery. The remaining Group 2 patients were New York Heart Association Classification I or II. For patients with severe LVSD undergoing CABG, pre-CPB RV dysfunction was associated with poor outcome. Patients with RVFAC >35% had a relatively uneventful perioperative course and good long-term survival, whereas patients with RVFAC 35% had a poor early and late outcome. Assessment of RV function is useful to further assess the risk of CABG.

IMPLICATIONS: Right ventricular function before cardiopulmonary bypass is associated with poor outcome after coronary artery surgery in patients with poor left ventricular function.

This article has been cited by other articles:

				H. Sugiki, K. Nakashima, E. Vermes, D. Loisance, and M. Kirsch Temporary Right Ventricular Support with Impella Recover RD Axial Flow Pump Asian Cardiovasc Thorac Ann, August 1, 2009; 17(4): 395 - 400. [Abstract] [Full Text] [PDF]

				F. Haddad, P. Couture, C. Tousignant, and A. Y. Denault The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: II. Pathophysiology, Clinical Importance, and Management Anesth. Analg., February 1, 2009; 108(2): 422 - 433. [Abstract] [Full Text] [PDF]

				F. Haddad, R. Doyle, D. J. Murphy, and S. A. Hunt Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure Circulation, April 1, 2008; 117(13): 1717 - 1731. [Full Text] [PDF]

				A. H. Alzeer, A. F. Al-Mobeirek, H. A. K. Al-Otair, U. A. F. Elzamzamy, I. A. Joherjy, and A. S. Shaffi Right and Left Ventricular Function and Pulmonary Artery Pressure in Patients With Bronchiectasis* Chest, February 1, 2008; 133(2): 468 - 473. [Abstract] [Full Text] [PDF]

				B. Qizilbash, P. Couture, and A. Denault Impact of Perioperative Transesophageal Echocardiography in Aortic Valve Replacement Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 288 - 300. [Abstract] [PDF]

				S. Chumnanvej, M. J. Wood, T. E. MacGillivray, and M. F. V. Melo Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation Anesth. Analg., September 1, 2007; 105(3): 583 - 601. [Abstract] [Full Text] [PDF]

				R. Salem, A. Y. Denault, P. Couture, S. Belisle, A. Fortier, M.-C. Guertin, M. Carrier, and R. Martineau Left ventricular end-diastolic pressure is a predictor of mortality in cardiac surgery independently of left ventricular ejection fraction Br. J. Anaesth., September 1, 2006; 97(3): 292 - 297. [Abstract] [Full Text] [PDF]

				Y. Shi, A. Y. Denault, P. Couture, A. Butnaru, M. Carrier, and J.-C. Tardif Biventricular diastolic filling patterns after coronary artery bypass graft surgery J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1080 - 1086. [Abstract] [Full Text] [PDF]

				R. M. Lang, M. Bierig, R. B. Devereux, F. A. Flachskampf, E. Foster, P. A. Pellikka, M. H. Picard, M. J. Roman, J. Seward, J. Shanewise, et al. Recommendations for chamber quantification Eur J Echocardiogr, March 1, 2006; 7(2): 79 - 108. [Abstract] [Full Text] [PDF]

				R. De Simone, I. Wolf, S. Mottl-Link, B. W. Bottiger, H. Rauch, H.-P. Meinzer, and S. Hagl Intraoperative assessment of right ventricular volume and function Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 988 - 993. [Abstract] [Full Text] [PDF]

				J. Fox, K. Glas, M. Swaminathan, and S. Shernan The Impact of Intraoperative Echocardiography on Clinical Outcomes Following Adult Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 25 - 40. [Abstract] [PDF]

				S. Fortier, R.G. DeMaria, Y. Lamarche, O. Malo, A. Denault, F. Desjardins, M. Carrier, and L.P. Perrault Inhaled prostacyclin reduces cardiopulmonary bypass-induced pulmonary endothelial dysfunction via increased cyclic adenosine monophosphate levels J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 109 - 116. [Abstract] [Full Text] [PDF]