Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery

2022 ◽  
pp. 154-180
Author(s):  
Muath Bishawi ◽  
Carmelo A. Milano
Keyword(s):  
Cardiac Surgery ◽  
Ventricular Failure

scholarly journals The Use of Large Doses of Adrenaline and Other Vasopressors in the Low Cardiac Output Syndrome after Cardiac Surgery—A Report of Four Cases

1974 ◽  
Vol 2 (1) ◽  
pp. 58-68 ◽  
Author(s):  
V. I. Callanan ◽  
G. A. Harrison
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Myocardial Metabolism ◽  
Favourable Effect ◽  
Ventricular Failure ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Blood Volume Expansion ◽  
Adrenaline Infusion ◽  
High Doses

Four cases are described of the use of prolonged and/or high doses of adrenaline in the treatment of the low cardiac output syndrome following cardiac surgery. Adrenaline was chosen because it produced a more favourable effect on central cardiovascular haemodynamics and myocardial metabolism when compared with isoprenaline, while its detrimental effects on renal function were less marked than those found when using noradrenaline. The renal insufficiency encountered was reversed in those cases without previous renal disease. Tachyphylaxis was demonstrated and weaning was achieved by gradual withdrawal of the vasopressor with concomitant blood volume expansion. Two cases with predominant right ventricular failure developed gross ascites and peripheral oedema, making control of fluid balance difficult. These problems are discussed with a summary of the relevant pharmacology of isoprenaline, noradrenaline, adrenaline and glucagon. The conclusions reached regarding the use and management of adrenaline infusion are given.

scholarly journals Biomarkers in the Diagnosis, Management, and Prognostication of Perioperative Right Ventricular Failure in Cardiac Surgery—Are We There Yet?

2019 ◽  
Vol 8 (4) ◽  
pp. 559 ◽  
Author(s):  
Habib Jabagi ◽  
Lisa M. Mielniczuk ◽  
Peter P. Liu ◽  
Marc Ruel ◽  
Louise Y. Sun
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
Right Ventricular ◽  
Clinical Utility ◽  
Right Ventricular Failure ◽  
Current Evidence ◽  
Potential Utility ◽  
Ventricular Failure ◽  
Galectin 3 ◽  
Rv Function

Right ventricular failure (RVF) is a major risk factor for end organ morbidity and mortality following cardiac surgery. Perioperative RVF is difficult to predict and detect, and to date, no convenient, accurate, or reproducible measure of right ventricular (RV) function is available. Few studies have examined the use of biomarkers in RVF, and even fewer have examined their utility in the perioperative setting of patients undergoing cardiac surgery. Of the available classes of biomarkers, this review focuses on biomarkers of (1) inflammation and (2) myocyte injury/stress, due to their superior potential in perioperative RV assessment, including Galectin 3, ST2/sST2, CRP, cTN/hs-cTn, and BNP/NT-proBNP. This review was performed to help highlight the importance of perioperative RV function in patients undergoing cardiac surgery, to review the current modalities of RV assessment, and to provide a review of RV specific biomarkers and their potential utilization in the clinical and perioperative setting in cardiac surgery. Based on current evidence, we suggest the potential utility of ST2, sST2, Gal-3, CRP, hs-cTn, and NT-proBNP in predicting and detecting RVF in cardiac surgery patients, as they encompass the multifaceted nature of perioperative RVF and warrant further investigation to establish their clinical utility.

scholarly journals Postoperative Right Ventricular Failure in Cardiac Surgery

2016 ◽  
Vol 7 (6) ◽  
pp. 185-195 ◽  
Author(s):  
Victor H. Nieto Estrada ◽  
Daniel L. Molano Franco ◽  
Albert A. Valencia Moreno ◽  
Jose A. Rojas Gambasica ◽  
Cristian C. Cortes Nunez
Keyword(s):  
Cardiac Surgery ◽  
Right Ventricular ◽  
Right Ventricular Failure ◽  
Ventricular Failure

scholarly journals Post-operative Right Ventricular Failure After Cardiac Surgery: A Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
David Levy ◽  
Driss Laghlam ◽  
Philippe Estagnasie ◽  
Alain Brusset ◽  
Pierre Squara ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Cohort Study ◽  
Intensive Care ◽  
Right Ventricular ◽  
Odds Ratio ◽  
Valve Surgery ◽  
Right Ventricular Failure ◽  
Composite Outcome ◽  
Ventricular Failure

Introduction: Right ventricular failure (RVF) after cardiac surgery is an important risk factor for morbidity and mortality. Its diagnosis is challenging, and thus, its incidence and predictors are not well-established. We investigated the incidence, complications, and variables associated with clinically relevant post-operative RVF.Methods: We included all patients who underwent cardiac surgery with cardiopulmonary bypass between 2016 and 2019 in a cardiac surgery center with standardized diagnostic and therapeutic management of RVF. RVF was considered only if clinically relevant: associated with hemodynamic instability requiring catecholamine support and inhaled nitric oxide relayed by sildenafil.Results: Overall, 3,826 patients were included, of whom, 110 (2.9%) developed post-operative RVF. Mortality was not different among patients who developed post-operative RVF, compared with the rest of the cohort (1.8 vs. 0.7%, p = 0.17). Using a composite outcome that combined death, reintubation, stroke, and prolonged intensive care unit stay (more than 14 days) yielded an incidence of 6.6%, and RVF was associated with this composite outcome with an odds ratio of 3.6 (2.2–5.8), p < 0.001. In a multivariable model, pre-operative variables independently associated with post-operative RVF were pre-operative atrial fibrillation (AF) {adjusted odds ratio (adjOR) 3.22 [95% confidence interval (95%CI) = 1.94–5.36], p < 0.001}, left ventricle ejection fraction below 50% [adjOR = 2.55 (95%CI = 1.52–4.33), p < 0.001], systolic pulmonary artery pressure above 55 mmHg [adjOR = 8.64 (95%CI = 5.27–14.1); p < 0.001], mitral valve surgery [adjOR = 2.17 CI (95%CI = 1.28–3.66), p = 0.004], and tricuspid valve surgery [adjOR = 10.33 (95%CI = 6.14–17.4), p < 0.001]. In patients who developed post-operative RVF requiring treatment, 32 (29.1%) showed RV dysfunction before surgery.Conclusion: In this cohort study, 2.9% of patients developed clinically significant post-operative RVF. Moreover, RVF was associated with severe adverse outcomes, including death, strokes, reintubation, and prolonged intensive care unit stay.

scholarly journals Review Article: Management of Perioperative Anesthesia in Right Heart Failure

2018 ◽  
Vol 54 (1) ◽  
pp. 75
Author(s):  
Fajar Perdhana ◽  
Herdono Purnomo
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Right Heart

Right ventricular dysfunction and failure receive much less attention than the left ventricular failure. Right ventricular dysfunction or failure is associated with increased mortality rates in cardiac surgery, surgical cases other than cardiac surgery and also in patients treated in the ICU. The purpose of this article review was to describe the anatomy, physiology and pathophysiology of right ventricular failure, its detection and diagnosis, and management considerations from anesthetic point of view, including preoperative, intraoperative and postoperative stages. Cardiac surgery may result in right ventricular failure. For example, 0.1% post cardiotomy patients experience severe right heart failure and require long-term inotropic support, and so do 2-3% of post-transplant patients, and 20-30% of patients installed with instrument in his left heart. Therefore, anesthesiologists play a major role in perioperative and postoperative intensive care and are obliged to comprehend the nature of right ventricular dysfunction and failure so as to carry out early detection, prevent and manage patients with right ventricular dysfunction.

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