Document Type : Original Article
Authors
- Jamshid Abedi 1
- Mohammad Ebrahim Ghafari 2
- Jalal Kheirkhah 3
- Hassan Moladoust 4
- Mohammad Reza Aghajankhah 3
1 School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
2 Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
3 Department of Cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
4 Department of Biochemistry and Medical Physics, Healthy Heart Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Abstract
BACKGROUND: With the increase in the number of coronary artery bypass grafting (CABG) surgeries, the concern about complications after it has also increased. RV diastolic dysfunction (RVDD) is one of the post-CABG complications, and in this study, we intend to investigate its frequency and predictors.
METHODS: In this cross-sectional study, eighty CABG candidate adult patients were included. A history of previous heart surgery or arrhythmia were the main exclusion criteria. After recording demographic and clinical information, echocardiography of the right ventricle (RV) was performed the day before the surgery and seven days later. The functional parameters were obtained according to the Guidelines for the Echocardiographic Assessment of the Right Heart in Adults.
RESULTS: Eighty patients with an average age of 60.25 ± 8.93 years participated in the study. Most patients were male (72.5%). Thirteen patients had RVDD before CABG (30.8% grade I and 69.2% grade II). All these 13 patients had RVDD grade II after surgery (P=0.046). Among 67 patients with normal RV function before CABG, RV function was normal in only 20 patients (29.9%) after CABG. The incidence of grade I and grade II post-CABG RVDD (post-coronary artery bypass grafting right ventricle diastolic dysfunction) was 11.9% and 58.2%, respectively (P<0.001). Univariate logistic regression analysis showed that there was no association between pre-CABG variables, neither demographic nor echocardiographic, and the occurrence of RVDD after CABG.
CONCLUSION: CABG surgery is associated with a high incidence of RVDD, which cannot be predicted before surgery. The short-term and long-term consequences of this complication are still unknown.
Keywords
- Nia SKF, Mirhosseini S, Moshtaghion S, Abdollahi M, Hosseini H, Dehghanizadeh H, et al. Right pleural versus mediastinal drainage following elective off-pump coronary artery bypass. Tehran University of Medical Sciences. 2011;68(12): 726-31.
- GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151-1210. https://doi.org/10.1016/s0140-6736(17)32152-9
- Riley L, Cowan M, Abernethie A, Mozes R, Sheffer K. Non-Communicable Diseases Country Profiles 2014. Geneva: World Health Organization; 2014.
- Hajiabadi F. Survey on effect of coronary artery bypass graft surgery on quality of life of patients with coronary artery diseases. J Mashhad Sch Nurs Midwifery. 2008;19:58-64.
- Pačarić S, Turk T, Erić I, Orkić Ž, Petek Erić A, Milostić-Srb A, et al. Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study. Int J Environ Res Public Health. 2020 Feb 22;17(4):1417. https://doi.org/10.3390/ijerph17041417
- Hedbäck B, Perk J, Hörnblad M, Ohlsson U. Cardiac rehabilitation after coronary artery bypass surgery: 10-year results on mortality, morbidity and readmissions to hospital. J Cardiovasc Risk. 2001 Jun;8(3):153-8. https://doi.org/10.1177/174182670100800306
- Borde D, Joshi P, Joshi S, Asegaonkar B, Apsingekar P, Khade S, et al. Changes in Right Ventricular Function After Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth. 2021 Mar;35(3):811-9. https://doi.org/10.1053/j.jvca.2020.06.086
- John V, Thomas A, Chikkamadegowda MS, Jambunathan R. Effect of Off-pump Coronary Artery Bypass Graft Surgery on Transthoracic Echocardiographic Right Ventricular Function in Indian Patients. J Indian Acad Echocardiogr Cardiovasc Imaging. 2020;4(1):7-10. https://doi.org/10.4103/jiae.jiae_31_19
- Grønlykke L, Couture EJ, Haddad F, Amsallem M, Ravn HB, Raymond M, et al. Preliminary Experience Using Diastolic Right Ventricular Pressure Gradient Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2020 Aug;34(8):2116-25. https://doi.org/10.1053/j.jvca.2019.12.042
- Pandat S, Nagaura T, Nair SG, Uy-Evanado A, Stecker EC, Nichols GA, et al. An association between right ventricular dysfunction and sudden cardiac death. Heart Rhythm. 2020 Feb;17(2):169-74. https://doi.org/10.1016/j.hrthm.2019.10.021
- Egbe AC, Pellikka PA, Miranda WR, Bonnichsen C, Reddy YN, Borlaug BA, et al. Echocardiographic predictors of severe right ventricular diastolic dysfunction in tetralogy of Fallot: Relations to patient outcomes. Int J Cardiol. 2020 May 1;306:49-55. https://doi.org/10.1016/j.ijcard.2020.02.067
- Metkus TS, Suarez-Pierre A, Crawford TC, Lawton JS, Goeddel L, Dodd-o J, et al. Diastolic dysfunction is common and predicts outcome after cardiac surgery. J Cardiothorac Surg. 2018 Jun 15;13(1):67. https://doi.org/10.1186/s13019-018-0744-3
- Denault A, Bussières J, Arellano R, Finegan B, Gavra P, Haddad F, et al. A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients. Can J Anaesth. 2016 Oct;63(10):1140-53. https://doi.org/10.1097/01.sa.0000513505.81349.d8
- Ting P-C, Wu VC, Liao C-C, Chou A-H, Tsai F-C, Lin P-J, et al. Preoperative Right Ventricular Dysfunction Indicates High Vasoactive Support Needed After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2019 Mar;33(3):686-93. https://doi.org/10.1053/j.jvca.2018.07.048
- Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713. https://doi.org/10.1016/j.echo.2010.05.010
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-71. https://doi.org/10.1093/ehjci/jev014
- Vila Vda S, Rossi LA, Costa MC. Experiência da doença cardíaca entre adultos submetidos à revascularização do miocárdio [Heart disease experience of adults undergoing coronary artery bypass grafting surgery]. Rev Saude Publica. 2008 Aug;42(4):750-6. https://doi.org/10.1590/s0034-89102008005000035
- Fazlinejad A, Mohammadi A, Mottahedi B, Esfahanizadeh J. Right Ventricular Function before and after an uncomplicated Coronary Bypass Graft as Assessed by Pulsedwave Doppler Tissue Imaging of the Tricuspid Annulus. Med. J. Mashhad Univ. Med. Sci. 2009;52(4):203-8. https://doi.org/10.22038/mjms.2009.5411
- 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.
- Vonk MC, Sander MH, van den Hoogen FH, van Riel PL, Verheugt FW, van Dijk AP. Right ventricle Tei-index: a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr. 2007 Oct;8(5):317-21. https://doi.org/10.1016/j.euje.2006.06.002
- Singh A, Huang X, Dai L, Wyler D, Alfirevic A, Blackstone EH, et al. Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy. J Thorac Cardiovasc Surg. 2020 Apr;159(4):1430-8.e4. https://doi.org/10.1016/j.jtcvs.2019.04.035
- Sakata T, Mogi K, Sakurai M, Tani K, Hashimoto M, Shiko Y, et al. Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study. J Card Surg. 2020 Jul;35(7):1464-70. https://doi.org/10.1111/jocs.14611
- Sumin AN, Korok EV, Sergeeva TJ. Preexisting Right Ventricular Diastolic Dysfunction and Postoperative Cardiac Complications in Patients Undergoing Nonemergency Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth. 2021 Mar;35(3):799-806. https://doi.org/10.1053/j.jvca.2020.09.100
)