Perioperative protection for right heart in patients with apical displacement of tricuspid valve leaﬂets_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIN Zhen , LUO Ming , DU Lei ,  LIN Jing

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIN Jing, Email: linjing@wchscu.cn

Keywords：

Apical displacement of tricuspid valve leaﬂets; perioperative period; right heart protection

DOI：

10.7507/1007-4848.202005039

Video：

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The apical displacement of tricuspid valve leaﬂets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.

Citation： QIN Zhen, LUO Ming, DU Lei, LIN Jing. Perioperative protection for right heart in patients with apical displacement of tricuspid valve leaﬂets. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1403-1406. doi: 10.7507/1007-4848.202005039 Copy

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11.	Orczykowski M, Derejko P, Bodalski R, et al. Radiofrequency catheter ablation of accessory pathways in patients with Ebstein's anomaly: At 8 years of follow-up. Cardiol J, 2017, 24(1): 1-8.
12.	Durandy YD. Is there a rationale for short cardioplegia re-dosing intervals? World J Cardiol, 2015, 7(10): 658-664.
13.	Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
14.	Whitlock RP, Devereaux PJ, Teoh KH, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet, 2015, 386(10000): 1243-1253.
15.	Hetzer R, Hacke P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
16.	Ibrahim M, Tsang VT, Caruana M, et al. Cone reconstruction for Ebstein's anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg, 2015, 149(4): 1144-1150.
17.	Beer L, Szerafin T, Mitterbauer A, et al. Low tidal volume ventilation during cardiopulmonary bypass reduces postoperative chemokine serum concentrations. Thorac Cardiovasc Surg, 2014, 62(8): 677-682.
18.	Ventetuolo CE, Klinger JR. Management of acute right ventricular failure in the intensive care unit. Ann Am Thorac Soc, 2014, 11(5): 811-822.
19.	Konstam MA, Kiernan MS, Bernstein D, et al. Evaluation and management of right-sided heart failure: A scientific statement from the American Heart Association. Circulation, 2018, 137(20): e578-e622.
20.	Grant C Jr, Richards JB, Frakes M, et al. ECMO and right ventricular failure: Review of the literature. J Intensive Care Med, 2020. [Epub ahead of print].
21.	Bartko PE, Wiedemann D, Schrutka L, et al. Impact of right ventricular performance in patients undergoing extracorporeal membrane oxygenation following cardiac surgery. J Am Heart Assoc, 2017, 6(8): e005455.

1. Tretter JT. Sudden death in Ebstein's anomaly: are we killing our patients with surgery? Eur Heart J, 2018, 39(21): 1978-1980.
2. Sainathan S, da Fonseca da Silva L, da Silva JP. Ebstein's anomaly: contemporary management strategies. J Thorac Dis, 2020, 12(3): 1161-1173.
3. Srivastava AR, Bhoje A, Khangraut S, et al. External plication of the atrialized right ventricle in the repair of Ebstein's anomaly. Semin Thorac Cardiovasc Surg, Autumn, 2019, 31(3): 566-568.
4. Dearani JA, Mora BN, Nelson TJ, et al. Ebstein anomaly review: what's now, what's next? Expert Rev Cardiovasc Ther, 2015, 13(10): 1101-1109.
5. Waldmann V, Khairy P. Ventricular arrhythmias and sudden death in patients with Ebstein anomaly: insights from a retrospective cohort study. J Thorac Dis, 2018, 10(Suppl 18): S2172-S2175.
6. Ross FJ, Latham GJ, Richards M, et al. Perioperative and anesthetic considerations in Ebstein's anomaly. Semin Cardiothorac Vasc Anesth, 2016, 20(1): 82-92.
7. Yuan SM. Ebstein's anomaly: Genetics, clinical manifestations, and management. Pediatr Neonatol, 2017, 58(3): 211-215.
8. Luo M, Lin J, Qin Z, et al. Prevention preferable to treatment: 3 case reports of patients experiencing right-sided heart failure after Ebstein anomaly correction. Medicine, 2017, 96(1): e5627.
9. Wackel P, Cannon B, Dearani J, et al. Arrhythmia after cone repair for Ebstein anomaly: The Mayo Clinic experience in 143 young patients. Congenit Heart Dis, 2018, 13(1): 26-30.
10. Walsh EP. Ebstein's anomaly of the tricuspid valve: A natural laboratory for re-entrant tachycardias. JACC Clin Electrophysiol, 2018, 4(10): 1271-1288.
11. Orczykowski M, Derejko P, Bodalski R, et al. Radiofrequency catheter ablation of accessory pathways in patients with Ebstein's anomaly: At 8 years of follow-up. Cardiol J, 2017, 24(1): 1-8.
12. Durandy YD. Is there a rationale for short cardioplegia re-dosing intervals? World J Cardiol, 2015, 7(10): 658-664.
13. Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
14. Whitlock RP, Devereaux PJ, Teoh KH, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet, 2015, 386(10000): 1243-1253.
15. Hetzer R, Hacke P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein's anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
16. Ibrahim M, Tsang VT, Caruana M, et al. Cone reconstruction for Ebstein's anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg, 2015, 149(4): 1144-1150.
17. Beer L, Szerafin T, Mitterbauer A, et al. Low tidal volume ventilation during cardiopulmonary bypass reduces postoperative chemokine serum concentrations. Thorac Cardiovasc Surg, 2014, 62(8): 677-682.
18. Ventetuolo CE, Klinger JR. Management of acute right ventricular failure in the intensive care unit. Ann Am Thorac Soc, 2014, 11(5): 811-822.
19. Konstam MA, Kiernan MS, Bernstein D, et al. Evaluation and management of right-sided heart failure: A scientific statement from the American Heart Association. Circulation, 2018, 137(20): e578-e622.
20. Grant C Jr, Richards JB, Frakes M, et al. ECMO and right ventricular failure: Review of the literature. J Intensive Care Med, 2020. [Epub ahead of print].
21. Bartko PE, Wiedemann D, Schrutka L, et al. Impact of right ventricular performance in patients undergoing extracorporeal membrane oxygenation following cardiac surgery. J Am Heart Assoc, 2017, 6(8): e005455.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative protection for right heart in patients with apical displacement of tricuspid valve leaﬂets

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