TY - JOUR
T1 - Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery
T2 - A prospective observational study
AU - Korshin, Andre
AU - Grønlykke, Lars
AU - Nilsson, Jens Christian
AU - Møller-Sørensen, Hasse
AU - Ihlemann, Nikolaj
AU - Kjøller, Sven Morten
AU - Damgaard, Sune
AU - Lehnert, Per
AU - Hassager, Christian
AU - Kjaergaard, Jesper
AU - Ravn, Hanne Berg
PY - 2019/8
Y1 - 2019/8
N2 - Objectives: Longitudinal shortening constitutes most of the right ventricle (RV) contraction in the normal heart. However, after even uncomplicated cardiac surgery with preserved RV function a significant and sustained decrease in longitudinal contraction expressed as a reduction in tricuspid annular plane systolic excursion (TAPSE) has been observed. Why and exactly when this happens remains unsettled. The aim of this study was to evaluate the magnitude and timing of changes in TAPSE in relation to sternotomy, pericardial opening, cardiopulmonary bypass (CPB), and chest closure. Methods: Fifty patients with normal preoperative ejection fraction and no valvulopathy, who underwent coronary artery bypass grafting with the use of CPB, were included. TAPSE was assessed using transthoracic echocardiography (TTE) at baseline and immediately after chest closure. Transesophageal echocardiography was performed at the following time points: after (1) anesthesia induction and transthoracic echocardiography; (2) sternotomy; (3) pericardiotomy; (4) completion of CPB; and (5) chest closure. Results: TAPSE was significantly reduced to approximately half of its initial value in all patients (from 22 [95% confidence interval, 21-23 mm] after anesthesia induction to 9 [95% confidence interval, 8-10 mm] after chest closure). No change was seen after pericardiotomy. The most prominent reduction (30%-40%) was observed after weaning from CPB. An additional significant decrease of 13% to 16% was seen after chest closure. Conclusions: TAPSE was consistently reduced to approximately half of its initial value after uncomplicated coronary artery bypass grafting surgery. The reduction happened mainly after weaning from CPB, possibly reflecting conformational change of the RV.
AB - Objectives: Longitudinal shortening constitutes most of the right ventricle (RV) contraction in the normal heart. However, after even uncomplicated cardiac surgery with preserved RV function a significant and sustained decrease in longitudinal contraction expressed as a reduction in tricuspid annular plane systolic excursion (TAPSE) has been observed. Why and exactly when this happens remains unsettled. The aim of this study was to evaluate the magnitude and timing of changes in TAPSE in relation to sternotomy, pericardial opening, cardiopulmonary bypass (CPB), and chest closure. Methods: Fifty patients with normal preoperative ejection fraction and no valvulopathy, who underwent coronary artery bypass grafting with the use of CPB, were included. TAPSE was assessed using transthoracic echocardiography (TTE) at baseline and immediately after chest closure. Transesophageal echocardiography was performed at the following time points: after (1) anesthesia induction and transthoracic echocardiography; (2) sternotomy; (3) pericardiotomy; (4) completion of CPB; and (5) chest closure. Results: TAPSE was significantly reduced to approximately half of its initial value in all patients (from 22 [95% confidence interval, 21-23 mm] after anesthesia induction to 9 [95% confidence interval, 8-10 mm] after chest closure). No change was seen after pericardiotomy. The most prominent reduction (30%-40%) was observed after weaning from CPB. An additional significant decrease of 13% to 16% was seen after chest closure. Conclusions: TAPSE was consistently reduced to approximately half of its initial value after uncomplicated coronary artery bypass grafting surgery. The reduction happened mainly after weaning from CPB, possibly reflecting conformational change of the RV.
KW - anatomic M-mode
KW - chest closure
KW - coronary artery bypass surgery
KW - echocardiography
KW - heart surgery
KW - M-mode
KW - pericardiotomy
KW - perioperative echocardiography
KW - pulmonary artery velocity time integral
KW - right ventricular (RV) function
KW - TAPSE reduction
KW - tissue Doppler velocity
KW - transesophagealechocardiography
KW - transthoracic
KW - tricuspid annular plane systolic excursion (TAPSE)
U2 - 10.1016/j.jtcvs.2018.09.114
DO - 10.1016/j.jtcvs.2018.09.114
M3 - Journal article
C2 - 30527715
AN - SCOPUS:85057811413
SN - 0022-5223
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -