Vol 15, No 3 (2019):99-105

Right ventricular dysfunction and associated factors in patients after coronary artery bypass grafting

Madjid Chinikar, Mohammad Rafiee, Mohammadreza Aghajankhah, Mahboobeh Gholipour, Tolou Hasandokht, Vali Imantalab, Ali Mirmansouri, Ali Mohammadzadeh, Nassir Nassiri-Sheikhani, Mona Naghshbandi, Mahsa Pourabdollah, Mohammad Esmaeil Rezaee, Abbas Sedighinejad, Alimohammad Sadeghi-Meibodi, Heidar Dadkhah-Tirani

DOI: http://dx.doi.org/10.22122/arya.v15i3.1765


BACKGROUND: Coronary artery bypass grafting (CABG) surgery is widely accepted as a revascularization method for coronary artery disease (CAD). Despite survival benefit and improvement in quality of life, CABG may impose major morbidities and significant complications. Right ventricle (RV) dysfunction is an important complication that may affect patient's longevity and functional capacity. The aim of this study was to evaluate the relationship between RV dysfunction and some invisible parameters like inferior vena cava (IVC) size with physical capacity.

METHODS: In this prospective study, 61 eligible CABG candidates were enrolled and RV function was assessed by echocardiographic parameters before CABG and one week and six months after the procedure, using tricuspid annular plane systolic excursion (TAPSE), Tei Index (TI), peak systolic movement (Sm) (cm/s), and IVC size. Functional capacity was assessed by six-minute walk test (6-MWT) 6 months after CABG.

RESULTS: 58 patients who did not have any perioperative RV dysfunction were remained until the end of study; mean age was 58.2 ± 7.9 years with 68.9% being men, and 3 patients died after CABG. Preoperatively, septal motion, RV indices, and IVC size were normal in all patients. The frequency of RV dysfunction according to abnormal TAPSE index, TI, and peak Sm one week after surgery was 81.0%, 79.0%, and 62.0%, respectively, and 6 months after surgery was 49.0%, 49.0%, and 37.0%, respectively. Mean walked distance in 6-MWT was significantly less in patients with RV dysfunction, older age, and higher number of involved vessels (P < 0.001).

CONCLUSION: The significant reduction in RV function and impairment of exercise capacity after CABG in this study suggests cardiologists to pay more attention to RV assessment in follow-up visits of patients undergoing GABG.


Coronary Artery Bypass Surgery; Right Ventricle; Inferior Vena Cava

Full Text:



Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA 2005; 294(10): 1255-9.

Jousilahti P, Laatikainen T, Salomaa V, Pietila A, Vartiainen E, Puska P. 40-year CHD mortality trends and the role of risk factors in mortality decline: the North Karelia project experience. Global heart. 2016; 11(2): 207-12.

Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization. Eur Heart J 2010; 31(20): 2501-55.

Li Z, Kravitz RL, Marcin JP, Romano PS, Rocke DM, Denton TA, et al. Survival enhancing indications for coronary artery bypass graft surgery in California. BMC Health Serv Res 2008; 8: 257.

Passaloglou IT, Sabashnikov A, Zeriouh M, Reutter S, Fatullayev J, Choi YH, et al. Rapid diagnostics and treatment of early complications after CABG surgery: A life saver. Heart Surg Forum 2013; 16(6): E346-E350.

Rosner A, Avenarius D, Malm S, Iqbal A, Schirmer H, Bijnens B, et al. Changes in right ventricular shape and deformation following coronary artery bypass surgery-insights from echocardiography with strain rate and magnetic resonance imaging. Echocardiography 2015; 32(12): 1809-20.

Pouleur AC, Rousseau MF, Ahn SA, Amzulescu M, Demeure F, de Meester C, et al. Right ventricular systolic dysfunction assessed by cardiac magnetic resonance is a strong predictor of cardiovascular death after coronary bypass grafting. Ann Thorac Surg 2016; 101(6): 2176-84.

Itagaki S, Hosseinian L, Varghese R. Right ventricular failure after cardiac surgery: Management strategies. Semin Thorac Cardiovasc Surg 2012; 24(3): 188-94.

Siddiqui MM, Jalal A, Sherwani M, Ahmad MZ. Right ventricular dysfunction after coronary artery bypass grafting is a reality of unknown cause and significance. Heart Surg Forum 2012; 15(4): E185-E188.

Daly RC, Chandrasekaran K, Cavarocchi NC, Tajik

AJ, Schaff HV. Ischemia of the interventricular septum. A mechanism of right ventricular failure during mechanical left ventricular assist. J Thorac Cardiovasc Surg 1992; 103(6): 1186-91.

Joshi SB, Salah AK, Mendoza DD, Goldstein SA, Fuisz AR, Lindsay J. Mechanism of paradoxical ventricular septal motion after coronary artery bypass grafting. Am J Cardiol 2009; 103(2): 212-5.

Diller GP, Wasan BS, Kyriacou A, Patel N, Casula RP, Athanasiou T, et al. Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography. Eur J Cardiothorac Surg 2008; 34(5): 995-9.

Alam M, Hedman A, Nordlander R, Samad B. Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus. Am Heart J 2003; 146(3): 520-6.

Pegg TJ, Selvanayagam JB, Karamitsos TD, Arnold RJ, Francis JM, Neubauer S, et al. Effects of off-pump versus on-pump coronary artery bypass grafting on early and late right ventricular function. Circulation 2008; 117(17): 2202-10.

Joshi SB, Roswell RO, Salah AK, Zeman PR, Corso PJ, Lindsay J, et al. Right ventricular function after coronary artery bypass graft surgery a magnetic resonance imaging study. Cardiovasc Revasc Med 2010; 11(2): 98-100.

Hedman A, Alam M, Zuber E, Nordlander R, Samad BA. Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: A tricuspid annular motion-based study. J Am Soc Echocardiogr 2004; 17(2): 126-31.

Lella LK, Sales VL, Goldsmith Y, Chan J, Iskandir M, Gulkarov I, et al. Reduced right ventricular function predicts long-term cardiac re-hospitalization after cardiac surgery. PLoS One 2015; 10(7): e0132808.

Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald's heart disease: A textbook of cardiovascular medicine. Philadelphia, PA: Elsevier/Saunders; 2015.

Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Eur Heart J 2007; 28(20): 2525-38.

Ojaghi Z, Moaref A, Nouhi F, Maleki M, Mohebi A. Evaluation of right ventricular function after coronary artery bypass grafting. Iran Heart J 2007; 8(1): 13-9.

Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME. Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesth Analg 2002; 95(6): 1507-18, table.

Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, et al. Right ventricular function and failure: Report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation 2006; 114(17): 1883-91.

Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: Executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28(1): 88-136.

El-Hamamsy I, Cartier R, Demers P, Bouchard D, Pellerin M. Long-term results after systematic off-

pump coronary artery bypass graft surgery in 1000 consecutive patients. Circulation 2006; 114(1 Suppl): I486-I491.

Gonenc A, Hacisevki A, Bakkaloglu B, Soyagir A, Torun M, Karagoz H, et al. Oxidative stress is decreased in off-pump versus on-pump coronary artery surgery. J Biochem Mol Biol 2006; 39(4): 377-82.

Gasz B, Lenard L, Racz B, Benko L, Borsiczky B, Cserepes B, et al. Effect of cardiopulmonary bypass on cytokine network and myocardial cytokine production. Clin Cardiol 2006; 29(7): 311-5.

Davidson MJ. Can the off-pump coronary artery bypass debate shed light on postoperative right heart dysfunction? Circulation 2008; 117(17): 2181-3.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.