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Right Ventricle Response to Major Lung Resection (the RIVER Study)
Enrico Giustiniano1, Fulvio Nisi1, Federico Piccioni1
1Department of Anesthesia and Intensive Care, IRCCS, Humanitas Research Hospital, Milan, Italy.
Journal of Cardiovascular Echography
|September 29, 2023
Summary
Major lung resection temporarily impairs right ventricle (RV) function and RV-pulmonary artery (PA) coupling, increasing RV afterload. However, these changes are not clinically significant, suggesting other factors contribute to cardiac failure after pulmonary embolism.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Major lung resection significantly increases risks of postoperative morbidity and mortality, primarily due to cardiorespiratory complications.
- The right ventricle (RV) is highly sensitive to afterload changes; acute increases, like in pulmonary embolism (PE), can lead to RV dilatation, reduced left ventricle compliance, cardiogenic shock, and death.
- Understanding RV performance changes after lung resection is crucial for managing cardiorespiratory complications.
Purpose of the Study:
- To investigate changes in RV performance following major lung resection.
- To determine the incidence of early RV systolic dysfunction and assess RV-PA coupling post-lung resection.
Main Methods:
- Transthoracic echocardiography (TTE) was performed before and immediately after major lung resection.
- Evaluated RV systolic function using tricuspid annulus plane systolic excursion (TAPSE).
- Assessed RV-PA coupling via the TAPSE/pulmonary artery pressures (PAPs) ratio.
Main Results:
- Post-surgery, RV function parameters worsened significantly.
- TAPSE decreased from 24 mm to 18 mm (P=0.015), and PAPs increased from 26 mmHg to 30 mmHg (P=0.013).
- The TAPSE/PAPs ratio, indicating RV-PA coupling, decreased from 0.85 to 0.64 (P=0.002).
Conclusions:
- Major lung resection leads to increased RV afterload, reducing RV function.
- Despite measurable changes, the RV impairment observed was not clinically significant.
- The distinct clinical presentation of acute cor pulmonale in PE suggests cardiac failure involves more complex pathways than solely mechanical obstruction.
