Key result
Cardiac surgery in adult patients with congenital heart disease was associated with a significant decline in right ventricular function directly post-operatively (TAPSE 13 vs 22 mm, P<0.01), which did not fully recover at 18 months.
Why the study?
Does cardiac surgery lead to a decline in right ventricular function in adult patients with congenital heart disease?
Cohort (n=86)
Single-blind
No
Does cardiac surgery lead to a decline in right ventricular function in adult patients with congenital heart disease?
Absolute Event Rate: 13% vs 22%
p-value: p=<0.01
Adult patients with congenital heart disease experience a significant decline in right ventricular function directly after cardiac surgery that does not completely recover by 18 months.
Long-lasting RVF decline follows cardiac surgery in adult CHD; supports closer monitoring but leaves open need for targeted interventions.
Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac surgery in these patients. Adult CHD patients operated between January 2008 and December 2009 in the Academic Medical Centre in Amsterdam were studied. Clinical characteristics, laboratory tests, surgical data and intensive care unit outcome were obtained from medical records. RVF was measured by trans-thoracic echocardiography (TTE) and expressed by tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (RV S') and myocardial performance index (MPI) pre-operatively and direct, at intermediate and late follow up. Of a total of 185 operated, 86 patients (mean age 39 ± 13 years, 54% male) had echo data available. There was a significant fall in RVF after cardiac surgery. TAPSE and RV S' were significantly higher and MPI was significantly lower pre-operatively compared to direct post-operative values (TAPSE 22 ± 5 versus 13 ± 3 mm (P < 0.01), RV S' 11 ± 4 versus 8 ± 2 cm/s (P < 0.01) and MPI 0.36 ± 0.14 vs 0.62 ± 0.25; P < 0.01). There were no significant differences in left ventricular function pre-operatively compared to post-operative values. Right-sided surgery was performed in 33, left-sided surgery in 37 and both sided surgery in 16 patients. Decline in RVF was equal for those groups. Patients with severe decline in RVF, were patients who underwent tricuspid valve surgery. Decline in RVF was associated with post-operative myocardial creatine kinase level and maximal troponin T level. There was no association between decline in RVF and clinical outcome on the intensive care unit. 18 months post-operatively, most RVF parameters had recovered to pre-operative values, but TAPSE which remained still lower (P < 0.01). CHD patients have a decline in RVF directly after cardiac surgery, regardless the side of surgery. Although a gradual improvement was observed, complete recovery was not seen 18 months post-operatively.
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Schuuring et al. (2011) conducted a cohort in Congenital heart disease (n=86). Cardiac surgery vs. Pre-operative baseline was evaluated on Right ventricular function measured by tricuspid annular plane systolic excursion (TAPSE) directly post-operatively (p=<0.01). Cardiac surgery in adult patients with congenital heart disease was associated with a significant decline in right ventricular function directly post-operatively (TAPSE 13 vs 22 mm, P<0.01), which did not fully recover at 18 months.
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