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Right Ventricular Systolic Function in Off Pump Coronary Artery Bypass (OPCAB) and Its Measurement by Tricuspid Annular Plane Systolic Excursion

Harish R., Dept. of Cardiac Anesthesia, Narayana Medical College & Hospital, Nellore - 524003, Andhra Pradesh. , Harish R.* , Ramesh Srigiri** , Mahesh Vakamudi** , Ranjith B. Karthekeyan**

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Indian Journal of Anesthesia and Analgesia 4(2):p 509-516, April - June 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4217.25

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Abstract

Background & Aim: Right ventricle function significantly decreases after coronary artery bypass surgery; as one of the likely causes, such a condition is attributed to the use of cardiopulmonary pump (CPB). Because nowadays there is a tendency toward increasing use of off-pump coronary artery bypass (OPCAB) surgery, this study was conducted to evaluate the right ventricle function perioperatively by TAPSE and simultaneously assess the influence of RV systolic function on the perioperative outcome in terms of duration of ventilation, inotropic support, length of intensive care unit stay etc. in the perioperative period in off pump coronary artery bypass grafting. Methods: This Prospective observational study was conducted on 54 triple vessel disease patients elective OPCABG surgery. RV systolic function assessed by measuring
Tricuspid Annular Plane Systolic Excursion(TAPSE) by both TEE & Transthoracic ECHO. Results: RVEF is most used index of RV contractility normal RVEF – 40-76%. Statistically significant improvement of TAPSE values observed post grafting. The improvement of TAPSE values are observed irrespective of whether RCA or PDA grafted or  not. In this study, improved TAPSE values did not significantly improve periop outcome in elective OP CABG patients in terms of length of ICU stay, inotropic support and duration of ventilation. Conclusions: The RV systolic function can be assessed routinely in perioperative setting by using TAPSE with relative easy. There is significant improvement in RV systolic function post grafting in elective OFFPUMP CABG surgeries. The improvement of RV systolic function in irrespective of right coronary artery grafting. The improvement of RV systolic function did not influence perioperative outcome significantly. Limitations of this study may be small sample size, Intra observer variations associated with echocardiography.
  

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4217.25

Keywords

Right Ventricle Function; Off-Pump Coronary Artery Bypass Surgery (OPCAB Surgery); Tricuspid Annular Plane Systolic Excursion.

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