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Evolution of right ventricular performance after CABG
O Bastien1, P G Durand, M George
1Département d'Anesthésie Réanimation, Hôpital Cardiovasculaire et Pneumologique L. Pradel, Lyon, France.
Insights
Post-coronary artery bypass graft (CABG) surgery, patients experience reduced right ventricular function and ejection fraction. Postoperative tachycardia may also increase the risk of myocardial ischemia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Coronary artery bypass graft (CABG) surgery is a major cardiac procedure.
- Understanding postoperative cardiac performance is crucial for patient recovery.
- Right ventricular function can be significantly impacted by cardiac surgery and mechanical ventilation.
Purpose of the Study:
- To evaluate right ventricular performance in patients undergoing CABG surgery during the postoperative period.
- To assess changes in cardiac index and right ventricular ejection fraction (RVEF) after CABG.
- To investigate the potential impact of postoperative tachycardia on myocardial ischemia.
Main Methods:
- A study of 34 patients undergoing CABG surgery.
- Cardiac output was measured using a cardiac output computer.
- Measurements were taken before anesthesia (T1) and at six intervals post-surgery, including during and after mechanical ventilation.
Main Results:
- Cardiac index decreased in the first six postoperative hours (2.56 to 2.41.mn-1.m2).
- Right Ventricular Ejection Fraction (RVEF) significantly dropped post-surgery (0.48 to 0.37) and further during weaning (0.43 to 0.36).
- Postoperative heart rate increased from 59 to 95 bpm, potentially contributing to myocardial ischemia.
Conclusions:
- Patients undergoing CABG surgery exhibit signs of right ventricular depression post-operation and during weaning.
- The observed decrease in RVEF suggests impaired right ventricular performance.
- Postoperative tachycardia is a potential risk factor for myocardial ischemia in this patient population.
Abstract:
34 patients scheduled for coronary artery bypass graft (CABG) surgery were studied during postoperative period. Right ventricular performance was specially performed with use of cardiac output computer REF-1 Edwards Lab., before Anaesthesia (T1) and at 6 investigation times after surgery during and after mechanical ventilation. The sixth first postoperative hours were marked by a decrease of cardiac index (2.56 +/- 0.4 to 2.41 +/- 0.41.mn-1.m2) and right Ventricular Ejection Fraction (RVEF) (0.48 +/- 0.07 to 0.37 +/- 0.09). The second period was the weaning period with a further drop of RVEF (0.43 +/- 0.1 to 0.36 +/- 0.07) without change in cardiac index (2.80 +/- 0.51.mn-1.m2, suggesting a ventricular post-operative and weaning depression, as previously described for the left ventricle. In addition, postoperative tachycardia (Heart rate = 59 +/- 9 at T1 to 95 +/- 14 at T7) may contribute to myocardial ischemia.