• Asha Singh, Xiaojie Huang, Lu Dai, Daniel Wyler, Andrej Alfirevic, Eugene H Blackstone, Gosta B Pettersson, and Andra E Duncan.
• Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
• J. Thorac. Cardiovasc. Surg. 2020 Apr 1; 159 (4): 1430-1438.e4.

ObjectivesLong-axis right ventricular (RV) function, which provides nearly 80% of RV ejection, acutely decreases during cardiac surgery. RV dysfunction increases risk for perioperative morbidity and mortality. Our objective was to characterize the change in perioperative RV long-axis and global function by determining the influence of procedure type, surgical approach, and reoperative status and examining its temporal relationship to pericardiotomy versus cardiopulmonary bypass (CPB) and cardioplegia.MethodsStandardized transesophageal echocardiographic examinations (TEEs) were prospectively performed in 109 patients undergoing coronary artery bypass grafting, mitral or aortic valve surgery, and/or aortic surgery via full sternotomy, mini-sternotomy, or right thoracotomy. Mid-esophageal, 4-chamber views centered on the RV were recorded at 4 intraoperative time points, following: (1) anesthetic induction; (2) pericardiotomy; (3) CPB; and (4) chest closure. Long-axis RV function was assessed by tricuspid annular plane systolic excursion and 2-dimensional longitudinal RV strain, and global RV function by fractional area change (FAC), calculated off-line from 2-dimensional TEE images.ResultsTEE measures of RV function were significantly reduced after CPB compared with baseline (baseline vs after CPB: TAPSE 2.2 [Q1, Q3: 1.8, 2.5] vs 1.5 [1.1, 1.7] mm; RV strain -22 [-24, -18] vs -16 [-20, -14] %; FAC 45 [35, 51] vs 42 [34, 49] %), but not after pericardiotomy. Reduced RV function persisted after chest closure: tricuspid annular plane systolic excursion 1.3 [1.0, 1.6] mm, RV strain -16 [-18, -13]%, FAC 38 [31, 46] %. Reduced function was demonstrated across cardiac surgical procedures, approaches, and primary and reoperative surgery.ConclusionsAcute intraoperative reduction in RV function occurs following CPB, independent of procedural characteristics and pericardiotomy. Etiology and clinical implications of reduced perioperative RV function remain to be determined.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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