Is systolic right ventricular function reduced after thoracic non-cardiac surgery? A propensity matched echocardiographic analysis

Abstract

Purpose: To assess whether thoracic non-cardiac surgery has an influence on right ventricular function (RVF) compared to known impaired postoperative RV function after cardiac surgery. Methods: In all, 50 patients (mean age: 61 years), who underwent thoracic non-cardiac surgery were included and matched using propensity score to 50 patients, receiving coronary artery bypass graft surgery (CABG) (CABG matched ). All patients had transthoracic echocardiography (TTE) including two-dimensional speckle tracking (2D-STE) and tissue Doppler imaging (TDI) pre-and 1 week postoperatively. Results: No significant changes in RV measurements including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), RV fractional area change (RV-FAC), and 2D-STE of the RV and RV freewall within the thoracic non-cardiac surgery patients comparing pre-and postoperative values. Comparing RV TTE values between CABG matched patients and thoracic surgery patients, only TAPSE differed between groups preoperatively (p <0.0001), where postoperatively, all RV measurements differed significantly between the two groups: TAPSE (p <0.0001), TASV (p <0.001), RVFAC (p = 0.005), and RV 2D-STE (p <0.0001) indicating impairment of RV function post-CABG surgery compared to thoracic non-cardiac surgery. Conclusion: Thoracic non-cardiac surgery including an opening of the pleural cavity did not influence RV function early postoperative, whereas CABG surgery with pericardiot-omy led to an impaired global RV function.