title: Right Ventricular Depression After Cardiopulmonary Bypass for Valvular Surgery.
abstract: OBJECTIVE
  To assess if right ventricular (RV) dysfunction is associated with increased mortality after cardiac surgery.
  
  
  METHODS
  Post-hoc analysis of a single-center double-blind randomized controlled trial.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 120 patients undergoing simple or complex valvular surgery.
  
  
  METHODS
  Patients were randomized to receive intravenous amiodarone or placebo intraoperatively. As secondary analysis, patients were divided into those requiring or not requiring postoperative inotropic agents.
  
  
  RESULTS
  After cardiopulmonary bypass (CPB), there were significant increases in heart rate, cardiac index, systolic and mean arterial pressures, central venous pressure and pulmonary capillary wedge pressure with reduction in systemic vascular resistance (p<0.05). Right ventricular end-systolic area became larger in those without inotropes and tricuspid annular plane systolic excursion was reduced in all patients; mitral annular systolic velocities were higher in patients receiving inotropes. Both right- and left-sided Doppler signals were altered significantly after CPB, which may be attributed to increased filling pressure. Inotropic agents were required in 56 patients after CPB (47%). The use of inotropic agents was associated with increased left and right atrial velocities (p<0.05). There were no differences in postoperative complications between groups; however, the number of deaths at 6 years was increased in patients who received inotropes after CPB (p = 0.0247).
  
  
  CONCLUSIONS
  The increases in right-sided dimensions after CPB are associated with reduction in RV function and increased biventricular filling pressure, suggesting worsening biventricular function and interventricular dependence. Inotropic medications were associated with unaltered RV dimensions and increased biatrial activity.
authors.affiliation: Departments of Anesthesiology; Division of Critical Care, Centre Hospitalier de l'Université de Montréaland Montreal Heart Institute. Electronic address: andre.denault@gmail.com.
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.affiliation: Departments of Anesthesiology.
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.affiliation: Department of Medicine, Sacré-Coeur de Montréal Hospital, Montreal, Quebec, Canada.
authors.forename: Yanick
authors.initials: Y
authors.lastname: Beaulieu
authors.affiliation: Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Departments of Anesthesiology.
authors.forename: Alain
authors.initials: A
authors.lastname: Deschamps
authors.affiliation: Montreal Heart Institute Coordinating Center.
authors.forename: Anna
authors.initials: A
authors.lastname: Nozza
authors.affiliation: Cardiac Surgery, Montreal Heart Institute and Université de Montréal.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.affiliation: Medicine.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Department of Preventive and Social Medicine, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000639:trends; D004311:Double-Blind Method; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: amiodarone; cardiac surgery; cardiopulmonary bypass; inotropic agents; outcome; right ventricular function; transesophageal echocardiography