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The effect of pericardial incision on right ventricular systolic function: a prospective observational study
Charles J Bitcon1,2, Claude Tousignant3
1Department of Anesthesia, St Michael's Hospital, The University of Toronto, Toronto, ON, Canada. charles.bitcon@svha.org.au.
Insights
Coronary artery bypass graft surgery (CABG) does not immediately impact right ventricular (RV) systolic function after pericardiotomy. Echocardiographic markers of RV function remain stable until after cardiopulmonary bypass.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Right ventricular (RV) systolic function often declines post-coronary artery bypass graft surgery (CABG).
- The precise timing and etiology of these functional changes remain unclear.
- Intraoperative monitoring of RV function during CABG is crucial.
Purpose of the Study:
- To assess the immediate impact of pericardiotomy on RV systolic function during CABG.
- To monitor echocardiographic markers of RV systolic function intraoperatively.
- To investigate the timing of RV functional changes during CABG.
Main Methods:
- Observational study of 24 patients undergoing elective on-pump CABG.
- Utilized angle-independent speckle tracking and color tissue Doppler.
- Measured tricuspid annular plane systolic excursion (TAPSE), systolic velocity (S'), and other RV parameters at three intraoperative time points.
Main Results:
- No significant changes in RV systolic function parameters (TAPSE, S') were observed immediately after pericardiotomy.
- Adequate speckle tracking measurements were obtained in 21 patients.
- Significant reductions in RV systolic function parameters were noted only after cardiopulmonary bypass and chest closure.
Conclusions:
- Pericardial opening and suspension do not significantly affect RV systolic function indices.
- RV systolic function is preserved until after cardiopulmonary bypass in CABG patients.
- Speckle tracking and color tissue Doppler are valuable for intraoperative RV assessment.
Background:
Echocardiographic longitudinal markers of right ventricular (RV) systolic function are commonly depressed after coronary artery bypass graft surgery (CABG) despite an uncomplicated course and good clinical recovery. The exact timing and cause of these changes is unknown. The aim of this observational study was to monitor echocardiographic markers of RV systolic function intraoperatively during CABG. We used angle-independent speckle tracking to measure the primary endpoints of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S') before and after pericardiotomy.
Methods:
Twenty-four patients undergoing elective on-pump CABG were enrolled in the study. Speckle tracking-derived TAPSE, S', free wall systolic strain, RV outflow tract strain, colour tissue Doppler-derived isovolumic acceleration (IVA) and two-dimensional RV dimensions and fractional area change (FAC) were measured at three intraoperative time points: 1) after sternotomy immediately prior to pericardiotomy; 2) after pericardiotomy and placement of pericardial retraction sutures; and 3) following cardiopulmonary bypass after chest closure.
Results:
Adequate image quality to perform speckle tracking measurements was obtained in twenty-one patients. We found that there were no significant changes to echocardiographic parameters of RV systolic function between pre- and post-pericardiotomy. The mean (SD) of the primary endpoints were: TAPSE [28.1 (5.1) mm vs 27.7 (7.4) mm, respectively; mean difference, -0.4 mm; 97.5% confidence interval (CI), -4.0 to 3.1; P = 0.76] and S' [10.4 (2.1) cm·sec-1 vs 10.8 (1.9) cm·sec-1, respectively; mean difference, 0.4 cm·sec-1; 97.5% CI, -0.9 to 1.7; P = 0.48]. Significant reductions in the parameters of RV systolic function were found only after cardiopulmonary bypass and chest closure.
Conclusion:
Pericardial opening and suspension had no significant effect on the indices of RV systolic function derived from speckle tracking or colour tissue Doppler.
