Peri-operative Right Ventricular Failure

A problem that can clearly be served up to us all. But we’re more familiar with LV failure. So what shod we do? Read on…

Sascha Treskatch

  • The incidence is low (thankfully)
  • Predispositions
    • Cardiopulmonary bypass
    • Pulmonary hypertension
    • RV functional reduction
    • Hypervolaemia (!)
  • Consider what the RV function is like when assessing if the LV is going to be fluid responsive. Article here.
  • Guidelines recommend using echo. assessment first before more invasive measure used (of course)
  • 2 good articles telling us lots about the RV , and what gets done by us to worsen its function I and II
  • A nice little algorithm presented for management

Summary management

  • Adequate preload
  • Maintain a good MAP to ensure (right) coronary perfusion
  • Support contractility
  • Reduce PVR (PDE II inhibitors)
  • Transfer out (potentially for extracorporeal support)
  • Another little algorithm about what exactly to do (non-echo-based)

 

Some food for thought, and some guidance to think about at least. I think I will have a better idea of what to do, perhaps in what order now, and definitely think more about the RV/LV interactions.