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The Right Ventricle During Selective Lung Ventilation for Thoracic Surgery.

Meenal Rana1, Hakeem Yusuff1, Vasileios Zochios2

  • 1University Hospitals of Leicester National Health Service Trust, Department of Cardiothoracic Anesthesia and Critical Care Medicine, Glenfield Hospital, Leicester, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK.

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Right ventricular (RV) dysfunction is a risk in thoracic surgery due to one-lung ventilation (OLV). Understanding and preventing RV injury during OLV is crucial for patient outcomes.

Keywords:
one-lung ventilationright ventricular dysfunctionright ventricular failureright ventricular injurythoracic surgery

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Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • The right ventricle (RV) is increasingly recognized for its importance, yet RV dysfunction/failure is understudied in thoracic surgery.
  • While known in cardiac surgery, the incidence and impact of RV dysfunction/failure during thoracic procedures, especially with one-lung ventilation (OLV), remain unclear.

Purpose of the Study:

  • To explore the pathophysiology of RV dysfunction/failure in the unique context of thoracic surgery and OLV.
  • To introduce the concept of RV injury from intraoperative factors during OLV.
  • To discuss diagnostic and management strategies for RV dysfunction/failure in this setting.

Main Methods:

  • Literature review and discussion of pathophysiologic mechanisms.
  • Focus on intraoperative factors, including mechanical ventilation and its potential to cause lung and RV injury.
  • Emphasis on perioperative identification of at-risk patients using focused imaging, particularly echocardiography.

Main Results:

  • Thoracic surgery and OLV create a unique scenario with sudden changes in RV afterload, preload, and contractility.
  • Intraoperative mechanical ventilation is a key mechanism potentially leading to both ventilator-induced lung injury (VILI) and RV injury.
  • Early identification and protective strategies are essential for preventing RV dysfunction.

Conclusions:

  • RV injury during OLV is a significant concern in thoracic surgery, potentially leading to acute dysfunction.
  • Focused perioperative imaging, especially echocardiography, is vital for identifying at-risk patients.
  • Implementing RV-protective strategies and managing established RV failure are critical for improving patient outcomes.