title: Prevalence, Diagnosis, Perioperative Monitoring and Treatment of Right Ventricular Dysfunction and/or Pulmonary Arterial Hypertension in Cardiac Surgical Patients in Germany-A Postal Survey.
abstract: BackgroundSparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities.MethodsA postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers. Total 47 of 81 (58%) heart centers returned the questionnaires. The centers reported data on 51,095 patients, and 49.8% of the procedures were isolated coronary artery bypass grafting.ResultsData on the prevalence of preoperative pulmonary hypertension and/or right ventricular dysfunction were not available in 54% and 64.6% of centers. In the remaining hospitals, 19.5% of patients presented right heart dysfunction and 10% pulmonary arterial hypertension. Preoperative echocardiography was performed in only 45.3% of the coronary artery bypass grafting cases. Preoperative pharmacologic treatment of pulmonary hypertension or right ventricular dysfunction with oral sildenafil, inhaled prostanoids, or nitric oxide was initiated in 71% and 95.7% of the centers, respectively. Intra- and postoperative treatment was most frequently accomplished with phosphodiesterase-III inhibitors.ConclusionThe prevalence of preoperative right heart dysfunction and pulmonary arterial hypertension in cardiac surgical patients in Germany seems to be substantial. However, in more than 50% of the patients, no preoperative data on right ventricular function and pulmonary arterial pressure are available. This may lead to underestimation of perioperative risk and inappropriate management of this high-risk population.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany.
authors.forename: Julika
authors.initials: J
authors.lastname: Schön
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pliet
authors.affiliation: Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Haake
authors.affiliation: Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinecke
authors.affiliation: Department of Anesthesiology and Intensive Care, Charité University Hospital, Charité Campus Mitte and Virchow Klinikum, Berlin, Germany.
authors.forename: Marit
authors.initials: M
authors.lastname: Habicher
authors.affiliation: Department of Anesthesiology and Intensive Care, Charité University Hospital, Charité Campus Mitte and Virchow Klinikum, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.affiliation: Department of Cardiovascular Surgery, German Armed Forces Central Hospital, Koblenz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Markewitz
authors.affiliation: Department of Anesthesiology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
authors.affiliation: Department of Anesthesiology and Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Heinrich Volker
authors.initials: HV
authors.lastname: Groesdonk
authors.affiliation: Department of Cardiovascular and Vascular Surgery, Heart Center University Freiburg, Freiburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Trummer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarzyk
authors.affiliation: Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: von der Brelie
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, St. Georg Hospital, Hamburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.affiliation: Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schirmer
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004452:Echocardiography; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011651:Pulmonary Artery / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D016278:Ventricular Function, Right
chemical_list: D000959:Antihypertensive Agents