Work

Surgery versus Pharmacology in Right Ventricle Failure post CABG

Year: 2019

Type: article

Abstract: Objective: To compare pharmacology versus extra-corporal support in management of failing right ventricle post CABG Methods: From 2014 to Dec 2017, 23 patients complicated by right ventricle failure post CABG were included. Group A (10 patients) was managed by ECMO, Group B (13 patients) by pharmacology. Preoperative transthoracic echocardiography (TTE) was collected as well as TTE performed after surgery.Parasternal and apical views were obtained. RV systolic function was evaluated by means of tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler imaging (RV S'). TAPSE was obtained from the apical four-chamber view. The difference in the displacement of the right ventricular base from end-diastole to end-systole at the junction of the tricuspid valvular plane was used to determine TAPSE. Tissue Doppler imaging S (RV S') was measured using a pulsed wave Doppler sampling gate of 6-6 mm and a sweep of 100 mm/s. A value of TAPSE < 16 mm, and/or RV S' < 10 cm was considered abnormal and defined RV dysfunction. (10) Tt- Results: There was no difference regarding demographic data between groups, and ICU stay in group B was 12± 3 days while in group A it was 4±2 days. There was no statistical difference in bypass and ischemic time in both groups. Atrial fibrillation occurred in 5 cases in group group A, 8 in group B. RV parameters TAPSE, RV function, associated TR showed greater improvement in Group A than Group B. In-hospital mortality was 2 in Group B and 1 in Group A. Conclusions: We confirmed there is remarkable decline of RV systolic function after coronary artery bypass grafting and this dysfunction was associated with morbidity and mortality. Both pharmacology and surgical support have good outcome in management of RV dysfunction; however, mechanical support is superior in terms of low morbidity and mortality.

Source: Structural Heart

DOI: 10.1080/24748706.2019.1588571

Authors: Ehab Kasem, Alnzeer Othman

Institutions: Zagazig University, King Abdullah Medical City

Language: English

Topic: Mechanical Circulatory Support Devices

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,340