SHORT TERM OUTCOME OF PATIENTS WITH IMPAIRED RIGHT VENTRICULAR FUNCTION UNDERGOING LEFT SIDED RHEUMATIC VALVULAR REPLACEMENT
Samir Abdallah1, Ali Emad2, Tamer Elbanna2, Ashraf Abdelaziz2, Ahmed Ali2, Sahar Gamal3, Yehia Mahmoud4, Rasha Hosny4
1Cardiothoracic Surgery Department, Cairo University, Departments of 2Cardiothoracic Surgery, 3Cardiology, 4Anesthesia, National Heart Institute
Background and aim of the study: Right ventricular function is the primary determinant of prognosis and effort tolerance in many groups of patients. Clinicians require measures that are widely available, easily obtained, highly reproducible, and provide clear information on prognosis, likely response to therapy or provide feedback on the success of therapeutic interventions. However, RV function is notoriously difficult to evaluate, given its geometry, inter-relationship with the left ventricle, and sensitivity to alterations in pulmonary pressure. The aim of this study is to compare the short term outcome of patients with rheumatic left sided lesions associated with preoperative impaired right ventricular function receiving intermittent antegrade warm blood cardioplegia (IAWBC) with normothermia CPB versus intermittent antegrade perfusion of cold crystalloid cardioplegia (IACCC) with hypothermic CPB. Patients and methods: Forty four (44) patients with rheumatic left sided lesion undergoing valve replacement with or without tricuspid disease were associated with preoperative right ventricular dysfunction included in this study and were further divided into two groups: Group I (22 patients): was given intermittent perfusion of intermittent antegrade cold crystalloid cardioplegia (IACCC) with moderate hypothermia 30°C (CPB). Group II (22 patients): was given intermittent antegrade warm blood cardioplegia (IAWBC) with normothermia CPB. Results: The mortality rate was 9.01%. All mortality cases received cold cardioplegia. Percentage of patients received single dose cardioplegia (cross clamp time up to 50 min) was 41.2 % in cold group versus 31.9 % in warm group. Percentage of patients required mechanical ventilation up to 8 hours postoperative was 14.4% in cold group and 81.8% in warm group.Mean of change in TAPSE was -0.3155 (deterioration) in cold group versus 0.0918 (improvement) in warm group. Mean of change in RVOT distal was -0.6727 in cold group versus -0.1273 in warm group. Conclusion: Patients with preoperative impaired right ventricular function show more rapid weaning from mechanical ventilator when receiving Intermittent Antegrade Warm Blood Cardioplegia (IAWPC) compared with Intermittent Antegrade Cold Crystalloid Cardioplegia (IACCC). Echocardiography is and will remain the leading method of right ventricle (RV) assessment. Routine measurement of right ventricle dimension in parasternal long axis M-Mode is useless.
December 2013