Pneumonectomy; Status, Right Ventricular Dysfunction
Conditions
Keywords
Right Ventricle Disfunction, Pneumonectomy, Echocardiography
Brief summary
Major lung resection is associated with high post-operative morbidity and mortality and significant long-term decreased functional capacity, especially due to cardiorespiratory complications. RV (Right Ventricle) ejection, pulmonary artery pressure and tone are tightly coupled. The RV is exquisitely sensitive to changes in afterload. When pulmonary vascular reserve is compromised RV ejection may be also compromised, increasing right atrial pressure and limiting maximal cardiac output. Acute increase in RV outflow resistance, as may occur with acute pulmonary embolism will cause acute RV dilatation and, by ventricular interdependence, markedly decreased LV (Left Ventricle) compliance, rapidly spiraling to acute cardiogenic shock and death. Most of the studies on RV function after lung resection are small and have found different results, and sometimes conflicting findings. As far as the investigators know, there are no data on the incidence of the RV dysfunction after major lung resection (pneumonectomy/bilobectomy) and it's not clear if there is some direct association between the RV dysfunction and post-operative complications. If so, early detection of RV dysfunction after major lung resection could provide the opportunity for interventional therapy with consequent possible improvement of these patients' prognosis.
Detailed description
The aim of this study is to identify the incidence of early RV systolic dysfunction (defined as Tricuspid Annular Plane Systolic Excursion (TAPSE) \< 17 cm, S' (TDI) \< 10 cm/s) and estimate the RV-PA (Right Ventricle-Pulmonary Artery) coupling as indicated by Guazzi et all. (TAPSE/PAPs ratio, where PAPs is the Systolic Pulmonary Artery Pressure) after major lung resection (bilobectomy and pneumonectomy) using echocardiography, and to assess if these modifications (RV dysfunction and RV-PA coupling) may be associated with post-operative cardiopulmonary complications occurring during the hospitalization period. Investigators also intend to evaluate if these changes are associated with impaired functional capacity at 3 months after surgery.
Interventions
DIAGNOSTIC_TESTEchocardiography
Before and after right pneumonectomy or bi-lobectomy patients will receive echocardiography
Sponsors
Humanitas Clinical and Research Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Adults patients undergoing right pneumonectomy * Adults patients undergoing pulmonary bilobectomy
Exclusion criteria
* Left pneumonectomy (it will not permit TTE postoperatively) * Completion pneumonectomy * Patients suffering from any myocardial disease * Preceding Pulmonary Embolism * Pregnancy * Potential pregnancy * Patients enrolled into another trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of right ventricle disfunction | Immediately after the awakening from general anesthesia (Day 0) | Incidence of early RV systolic dysfunction (defined as TAPSE \< 17 mm, S' (TDI) \< 10 cm/s) and estimate the RV-PA coupling as indicated by Guazzi et al. (TAPSE/PAPs ratio mm/mmHg) after major lung resection (bilobectomy and pneumonectomy) using echocardiography. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative outcome | Within 3rd post-operative day | Pulmonary failure may be associated with post-operative pulmonary embolism |
| Right ventricle failure | Within 3rd post-operative day | RV dysfunction and RV-PA uncoupling may be associated with post-operative pulmonary hypertension occurring during the hospitalization period. |
| Post-operative quality of life | 3 months, post-operatively | DASI questionnaire |
Contacts
Primary ContactEnrico Giustiniano, MD
Backup ContactAntonio Messina
Outcome results
None listed