Right Ventricular Dysfunction in Cardiac Anesthesia: Perioperative Assessment and Underlying Mechanisms

The importance of right ventricular (RV) function has often been overlooked until recently; however, RV function is now recognized as a significant prognostic predictor in medically managing cardiovascular diseases and cardiac anesthesia. During cardiac surgery, the RV is often exposed to stressful conditions that could promote perioperative RV dysfunction, such as insufficient cardioplegia, volume overload, pressure overload, or pericardiotomy. Recent studies have shown that RV dysfunction during cardiac anesthesia could cause difficulty in weaning from cardiopulmonary bypass or even poor postoperative outcomes. Severe perioperative RV failure may be rare, with an incidence rate ranging from 0.1% to 3% in the surgical population; however, in patients who are hemodynamically unstable after cardiac surgery, almost half reportedly present with RV dysfunction. Notably, details of RV function, particularly during cardiac anesthesia, remain largely unclear since long-standing research has focused predominantly on the left ventricle (LV). Thus, this review aims to provide an overview of the current perspective on the perioperative assessment of RV dysfunction and its underlying mechanisms in adult cardiac surgery. This review provides an overview of the basic RV anatomy, physiology, and pathophysiology, facilitating an understanding of perioperative RV dysfunction; the most challenging aspect of studying perioperative RV is assessing its function accurately using the limited modalities available in cardiac surgery. We then summarize the currently available methods for evaluating perioperative RV function, focusing on echocardiography, which presently represents the most practical tool in perioperative management. Finally, we explain several perioperative factors affecting RV function and discuss the possible mechanisms underlying RV failure in cardiac surgery.