Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes

Area of Science:

• Cardiothoracic Surgery
• Cardiovascular Physiology
• Pulmonary Medicine

Background:

• Right ventricular (RV) dysfunction is a known complication after pulmonary resection, characterized by reduced RV ejection fraction and increased RV end-diastolic volume.
• Supraventricular arrhythmias, such as atrial fibrillation, are common post-pulmonary resection.
• Invasive and non-invasive methods can assess RV function, with advanced pulmonary artery catheters enabling continuous monitoring.

Purpose of the Study:

• To investigate early postoperative right ventricular (RV) dysfunction following major pulmonary resections.
• To compare the impact of pneumonectomy versus lobectomy on RV function and hemodynamics.
• To identify key hemodynamic parameters affected by pulmonary resection.

Main Methods:

• A prospective study involving 178 patients undergoing major pulmonary resections (36 pneumonectomy, 142 lobectomy).
• Insertion of a rapid response thermistor pulmonary artery catheter for continuous hemodynamic monitoring.
• Collection of preoperative and serial postoperative (3, 6, 12, 24, 48 hours) hemodynamic data, including RV function parameters.

Main Results:

• Pneumonectomy group showed significant changes in heart rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, RV ejection fraction, and RV end-diastolic volume index postoperatively.
• Lobectomy group also demonstrated significant changes in these parameters, though generally less pronounced than in the pneumonectomy group.
• Significant differences were observed between pneumonectomy and lobectomy groups in all measured postoperative parameters.

Conclusions:

• Major pulmonary resection leads to early right ventricular dysfunction, primarily driven by increased right ventricular afterload.
• RV dysfunction is more pronounced following pneumonectomy compared to lobectomy.
• Pulmonary resection significantly impacts heart rate, pulmonary artery pressures, pulmonary vascular resistance, and RV function parameters.