Download Right Heart Failure in Cardiac Surgical Patients

Right heart function session.
Date: Tuesday, April 1st, 2014 from 13:30-15:00
Talk: Right heart failure in cardiac surgical patients.
Alexander Mittnacht, MD; The Mount Sinai Medical Center New York
Objectives
At the conclusion of this educational activity, the participant should be able to:
1. Understand the pathophysiology of right heart failure.
2. Recognize the differences between acute versus chronic right heart
failure.
3. Describe treatment options.
Right heart failure (RHF) is a clinical syndrome with multiple etiologies. Chronic
RHF can be seen with severe left-sided heart failure from various causes, severe
lung disease, pulmonary hypertension, and associated with congenital heart
disease. Acute right heart failure can be seen in ischemic heart disease,
pulmonary embolism, and more relevant to the cardiac anesthesiologist following
cardiopulmonary bypass from poor myocardial protection, surgical complications,
air embolization, protamine reaction, and severe left ventricular dysfunction.
While the clinical manifestation of chronic RHF includes peripheral edema,
ascites, congestive hepatopathy associated derangements, etc., acute RHF
usually manifests as low cardiac output. Treatment options must address any of
the acutely reversible causes, inotropic support, RV afterload reduction,
maintaining RV perfusion pressure, mechanical support and ECMO. In addition
to discussing these topics in more detail, anesthetic management, monitoring,
and treatment options in patients with RHF, as well as clinical examples will be
presented highlighting various scenarios of RHF in the cardiac operating room.
References:
1) Haddad et al. The right ventricle in cardiac surgery, a perioperative
perspective: II. Pathophysiology, clinical importance, and management.
2) Thunberg et al. Pulmonary hypertension in patients undergoing cardiac
surgery: pathophysiology, perioperative management, and outcomes. J
Cardiothorac Vasc Anesth 2013;27:551-572
3) Greyson CR: Pathophysiology of right ventricular failure. Crit Care Med
2008;36:S57-S65