Heart Diseases, Heart Failure, Heart Valve Diseases, Postoperative Complications
Conditions
Keywords
Cardiac surgery, Echocardiography, Right ventricular dysfunction, Doppler, Portal vein Doppler, Ventricular function
Brief summary
Right ventricular (RV) failure after cardiac surgery is associated with morbidity and mortality, but is hard to diagnose with conventional echocardiographic means. RV dysfunction may be associated with hepatic congestion, which may have an effect on portal veinous flow, but this has not been extensively. The investigators aimed determine whether an increased pulsatility in the portal venous flow was associated with RV dysfunction, after cardiac surgery at risk of RV dysfunction: mitral and tricuspid valve procedures.
Detailed description
In cardiac surgical patients, RV dysfunction is associated with organ hypoperfusion and venous congestion leading to increased morbidity and mortality. Non-invasive methods used to assess RV function are 2D-echocardiographic measurement of tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (EF), RV fractional area change (FAC), 3D assessment of RV function, tissue Doppler assessment of velocities, and magnetic resonance imaging (MRI). Though MRI is the gold standard method to assess RV function, it cannot be used in the perioperative period. In the present prospective observational study, The investigators investigated the association between the pattern of portal venous flow and RV function as assessed by echocardiography in the postoperative period.
Interventions
OTHERcardiac surgery involving mitral or tricuspid valve repair procedure, with cardiopulmonary bypass
cardiac surgery involving mitral or tricuspid valve repair procedure, with cardiopulmonary bypass
Sponsors
CMC Ambroise Paré
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* More than 18 years old * Ability to provide an informed consent * Planned mitral and / or tricuspid valve surgery under cardiopulmonary bypass.
Exclusion criteria
* Insufficient echogenicity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Right ventricular failure | First 24 hours post cardiac surgery | 1. systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) 2. RV fractional area change below 35% 3. End-diastole diameter ratio between RV and left ventricle \> 0.6 4. Ratio between S and D wave or inverse D wave in supra-hepatic veins |
| Portal flow measured by Doppler | First 24 hours post cardiac surgery | flow pulsatility is assessed with the formula = 100 x (Vmax-Vmin)/Vmax. Time frame: First 24 hours post cardiac surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Concordance of RV dysfunction measurements | First 24 hours post cardiac surgery | Concordance of repeated measurements of : 1. systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) 2. RV fractional area change below 35% 3. End-diastole diameter ratio between RV and left ventricle \> 0.6 4. Ratio between S and D wave or inverse D wave in supra-hepatic veins |
| Preoperative RV dysfunction | 30 days before cardiac surgery | As defined 1. systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) 2. RV fractional area change below 35% 3. End-diastole diameter ratio between RV and left ventricle \> 0.6 4. Ratio between S and D wave or inverse D wave in supra-hepatic veins |
| Echocardiographic acquisition | First 24 hours post cardiac surgery | Feasability of all measurements (RV failure with the 4 criteria: 1. systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) 2. RV fractional area change below 35% 3. End-diastole diameter ratio between RV and left ventricle \> 0.6 4. Ratio between S and D wave or inverse D wave in supra-hepatic veins) |
| Cholestasis | one week after surgery | Conjugate bilirubin elevation above 12 mmol/L |
| Acute kidney injury | one week after surgery | defined by KDIGO criteria as creatininemia elevation above \> 26 micromol/L during the first 48 hours or +50% during the first week, oliguria with urine output less than 0.5 mL/kg/h during 6 hours. |
| Concordance of pulsatile flow assessment | First 24 hours post cardiac surgery | Concordance of repeated measurements of the venous portal flow Time frame: First 24 hours post cardiac surgery |
Countries
France
Outcome results
None listed