The impact of pericardial approach and myocardial protection onto postoperative right ventricle function reduction

• DOI: 10.1186/s13019-018-0726-5
• Publication Date: 2018-06-05T00:19:41Z
• Authors: Marco Zanobini; Claudia Loardi; Paolo Poggio; Gloria Tamborini; Fabrizio Veglia; Alessandro Di Minno; Veronika Myasoedova; Liborio Francesco...; Raoul Biondi; Mauro Pepi; Francesco Alamanni; Matteo Saccocci
• Keywords: Male; Cardioplegia; RD1-811; Heart Ventricles; Ventricular Dysfunction, Right; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Minimally invasive surgery; Anesthesiology; Ventricular Dysfunction; Mitral valve; Ventricular Function; Humans; Minimally Invasive Surgical Procedures; RD78.3-87.3; Cardiac Surgical Procedures; Valve repair; Aged; Cardioplegia; Echocardiography; Minimally invasive surgery; Mitral valve; Right ventricle; Valve repair; Aged; Cardiac Surgical Procedures; Echocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mitral Valve Insufficiency; Myocardium; Pericardium; Postoperative Complications; Sternotomy; Ventricular Dysfunction, Right; Ventricular Function, Right; Myocardium; Mitral Valve Insufficiency; Cardioplegia; Echocardiography; Minimally invasive surgery; Mitral valve; Right ventricle; Valve repair; Aged; Cardiac Surgical Procedures; Echocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mitral Valve Insufficiency; Myocardium; Pericardium; Postoperative Complications; Sternotomy; Ventricular Dysfunction, Right; Ventricular Function, Right; Surgery; Cardiology and Cardiovascular Medicine; Middle Aged; Sternotomy; 3. Good health; Right; Echocardiography; Ventricular Function, Right; Right ventricle; Surgery; Female; Cardiology and Cardiovascular Medicine; Pericardium; Research Article

The reduction of RV function after cardiac surgery is a well-known phenomenon. It could persist up-to one year after the operation and often leads to an incomplete recovery at follow-up echocardiographic control. The aim of the present study is to analyze the impact of different modalities of pericardial incision (lateral versus anterior) and of myocardial protection protocols (Buckberg versus Custodiol) onto postoperative RV dynamic by relating two- and three-dimensional echocardiographic parameters in patients undergoing mitral valve repair through minimally invasive or traditional surgery approach.We have analyzed 44 consecutive patients with severe degenerative mitral regurgitation who underwent mitral reparation with different surgical approach and cardioplegia type: Group 1 (17 pts): sternotomy with Buckberg cardioplegia protocol; Group 2 (10 pts): sternotomy with Custodiol cardioplegia; Group 3 (17 pts): mini-invasive surgery with Custodiol cardioplegia. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post-surgery to evaluate RV function by tricuspid annular plane systolic excursion (TAPSE).All patients underwent successful and uneventful. A postoperative TAPSE reduction was found in all groups. However, mini-invasive patients experienced a significant reduced variation versus traditional surgery.Mini-invasive mitral repair, with lateral incision of pericardium, reduces postoperative TAPSE fall, while cardioplegia protocol fails to have an impact onto longitudinal RV function. In our study, the RV seems to experience a clinically irrelevant geometrical modification too, whose entity appears to be less evident in case of lateral pericardial approach. These results could strengthen the use of minimally invasive approach also to preserve RV function.