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Review
. 2016 Dec;7(6):185-195.
doi: 10.14740/cr500e. Epub 2016 Dec 31.

Postoperative Right Ventricular Failure in Cardiac Surgery

Victor H Nieto Estrada  1 , Daniel L Molano Franco  1 , Albert A Valencia Moreno  1 , Jose A Rojas Gambasica  1 , Cristian C Cortes Nunez  1
Affiliations
Review

Postoperative Right Ventricular Failure in Cardiac Surgery

Victor H Nieto Estrada et al. Cardiol Res. 2016 Dec.

Abstract

Two cases of patients that developed right ventricular failure (RVF) after cardiac valve surgery are presented with a narrative revision of the literature. RVF involves a great challenge due to the severity of this condition; it has a low incidence among non-congenital cardiac surgery patients, is more likely associated with cardiovascular and pulmonary complications related to cardiopulmonary bypass (CPB), and is a cause of acute graft failure and of a higher early mortality in cardiac transplant. The morphologic and hemodynamic characteristics of the right ventricle and some specific factors that breed pulmonary hypertension after cardiac surgery are in favor of the onset of RVF. Due to the possibility of complications after cardiac valve repair or replacement, measures as appropriate hemodynamic monitoring, to manage oxygenation, ventilation, sedation, acid base equilibrium and perfusion goals are a requirement, as well as a normal circulating volume, and the prevention of a disproportionate rise in the afterload, to preserve the free wall of the right ventricle (RV) and the septum's contribution to the right ventricular global function and geometry. If there is no response to these basic measures, the use of advanced therapy with inotropics, intravenous or inhaled pulmonary vasodilation agents is recommended; the use of mechanical ventricular assistance stands as a last resource.

Keywords: Physiopathology; Postoperative cardiac surgery; Prevention and treatment; Right cardiac failure.

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Figures

Figure 1
Figure 1
Physiopathology of right ventricular failure. FRV: function right ventricle; PVR: pulmonary vascular resistance. Taken and adapted from [16].
Figure 2
Figure 2
Physiopathology of the right ventricle after surgery. Taken and adapted from [17].
Figure 3
Figure 3
Features based in the Frank-Starling law related with acute right ventricular failure at post-cardiac surgery. Figure taken and adapted from [13].
Figure 4
Figure 4
Management algorithm proposed in patients with postoperative right ventricular dysfunction.
See this image and copyright information in PMC

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