Perioperative right ventricular dysfunction in adult patients undergoing non-complex cardiac surgery: diagnosis and management

Abstract

Even though there is no precise consensus on definition of the right ventricular dysfunction and the right ventricular failure, their reported incidence after cardiac surgery ranges from 0.04% to 2.9%. Right ventricular dysfunction is clinically important because it has been consistently shown to have a negative impact on the perioperative outcomes. In this article we explore current evidence on perioperative diagnosis and management of adult patients with right ventricular dysfunction who are undergoing non-complex cardiac surgery. We propose criteria for the right ventricular dysfunction, describe its pathophysiological mechanisms, diagnostic and therapeutic options as well as current challenges. The function of the right ventricle is determined by preload, afterload, contractility, ventricular interdependence, and heart rhythm. These five factors should all be assessed in a particular patient. Right ventricular dysfunction is not always easy to confirm. Transthoracic and transesophageal echocardiography are the mainstay of diagnosis. Also, clinical and laboratory findings should be considered especially when the patient approaches the extreme of right ventricular dysfunction spectrum—right ventricular failure. Right ventricular failure should be anticipated, and management focused on its prevention and treatment of the underlying cause. The clinical aim is to optimise the volume status, minimise the right ventricular afterload, optimise right ventricular free wall and interventricular septum performance, and to maximise the left heart pressure work. If the patient does not respond to conservative therapy, mechanical support should be promptly considered.