Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study

Andre Korshin; Lars Grønlykke; Jens Christian Nilsson; Hasse Møller-Sørensen; Nikolaj Ihlemann; Sven Morten Kjøller; Sune Damgaard; Per Lehnert; Christian Hassager; Jesper Kjaergaard; Hanne Berg Ravn

doi:10.1016/j.jtcvs.2018.09.114

Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study

Andre Korshin^*, Lars Grønlykke, Jens Christian Nilsson, Hasse Møller-Sørensen, Nikolaj Ihlemann, Sven Morten Kjøller, Sune Damgaard, Per Lehnert, Christian Hassager, Jesper Kjaergaard, Hanne Berg Ravn

^*Corresponding author for this work

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Journal of Thoracic and Cardiovascular Surgery
ISSN	0022-5223
DOIs	https://doi.org/10.1016/j.jtcvs.2018.09.114
Publication status	Published - Aug 2019

Keywords

anatomic M-mode
chest closure
coronary artery bypass surgery
echocardiography
heart surgery
M-mode
pericardiotomy
perioperative echocardiography
pulmonary artery velocity time integral
right ventricular (RV) function
TAPSE reduction
tissue Doppler velocity
transesophagealechocardiography
transthoracic
tricuspid annular plane systolic excursion (TAPSE)

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10.1016/j.jtcvs.2018.09.114

http://www.jtcvs.org/article/S002252231832782X/pdf

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Korshin, A., Grønlykke, L., Nilsson, J. C., Møller-Sørensen, H., Ihlemann, N., Kjøller, S. M., Damgaard, S., Lehnert, P., Hassager, C., Kjaergaard, J., & Ravn, H. B. (2019). Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study. Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2018.09.114

Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery : A prospective observational study. / Korshin, Andre; Grønlykke, Lars; Nilsson, Jens Christian et al.

In: Journal of Thoracic and Cardiovascular Surgery, 08.2019.

Research output: Contribution to journal › Journal article › Research › peer-review

Korshin, A, Grønlykke, L, Nilsson, JC, Møller-Sørensen, H, Ihlemann, N, Kjøller, SM, Damgaard, S, Lehnert, P, Hassager, C, Kjaergaard, J & Ravn, HB 2019, 'Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2018.09.114

@article{33ca033b19b248a08225cb654662b7e6,

title = "Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study",

abstract = "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.",

keywords = "anatomic M-mode, chest closure, coronary artery bypass surgery, echocardiography, heart surgery, M-mode, pericardiotomy, perioperative echocardiography, pulmonary artery velocity time integral, right ventricular (RV) function, TAPSE reduction, tissue Doppler velocity, transesophagealechocardiography, transthoracic, tricuspid annular plane systolic excursion (TAPSE)",

author = "Andre Korshin and Lars Gr{\o}nlykke and Nilsson, {Jens Christian} and Hasse M{\o}ller-S{\o}rensen and Nikolaj Ihlemann and Kj{\o}ller, {Sven Morten} and Sune Damgaard and Per Lehnert and Christian Hassager and Jesper Kjaergaard and Ravn, {Hanne Berg}",

year = "2019",

month = aug,

doi = "10.1016/j.jtcvs.2018.09.114",

language = "English",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

}

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 -

Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study

Abstract

Keywords

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