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 - Kjærgaard, Jesper

AU - Ravn, Hanne Berg

PY - 2019

Y1 - 2019

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

VL - 158

SP - 480

EP - 489

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -