Detection of Right Ventricular Dysfunction by Portal Vein Doppler After Cardiac Surgery

Study Overview
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Brief Summary
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Right ventricular (RV) failure after cardiac surgery is associated with morbidity and mortality, but is hard to diagnose with conventional echocardiographic means. RV dysfunction may be associated with hepatic congestion, which may have an effect on portal veinous flow, but this has not been extensively. The investigators aimed determine whether an increased pulsatility in the portal venous flow was associated with RV dysfunction, after cardiac surgery at risk of RV dysfunction: mitral and tricuspid valve procedures.

Detailed Description
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In cardiac surgical patients, RV dysfunction is associated with organ hypoperfusion and venous congestion leading to increased morbidity and mortality. Non-invasive methods used to assess RV function are 2D-echocardiographic measurement of tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (EF), RV fractional area change (FAC), 3D assessment of RV function, tissue Doppler assessment of velocities, and magnetic resonance imaging (MRI). Though MRI is the gold standard method to assess RV function, it cannot be used in the perioperative period. In the present prospective observational study, The investigators investigated the association between the pattern of portal venous flow and RV function as assessed by echocardiography in the postoperative period.

Official Title
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Detection of Right Ventricular Dysfunction by Portal Vein Doppler After Cardiac Surgery

Conditions
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Postoperative Complications, Heart Diseases, Heart Failure, Heart Valve Diseases

Intervention / Treatment
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* Other: cardiac surgery involving mitral or tricuspid valve repair procedure, with cardiopulmonary bypass


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: More than 18 years old Ability to provide an informed consent Planned mitral and / or tricuspid valve surgery under cardiopulmonary bypass. Exclusion Criteria: Insufficient echogenicity

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Adults patients undergoing mitral and / or tricuspid valve surgery with cardiopulmonary bypass.<br> | Other: cardiac surgery involving mitral or tricuspid valve repair procedure, with cardiopulmonary bypass<br>* cardiac surgery involving mitral or tricuspid valve repair procedure, with cardiopulmonary bypass<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Right ventricular failure | systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins | First 24 hours post cardiac surgery | 
| Portal flow measured by Doppler | flow pulsatility is assessed with the formula = 100 x (Vmax-Vmin)/Vmax. Time frame: First 24 hours post cardiac surgery | First 24 hours post cardiac surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Echocardiographic acquisition | Feasability of all measurements (RV failure with the 4 criteria: systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins) | First 24 hours post cardiac surgery | 
| Echocardiographic acquisition | Feasability of all measurements (RV failure with the portal flow with Doppler) | First 24 hours post cardiac surgery | 
| Concordance of pulsatile flow assessment | Concordance of repeated measurements of the venous portal flow Time frame: First 24 hours post cardiac surgery | First 24 hours post cardiac surgery | 
| Concordance of RV dysfunction measurements | Concordance of repeated measurements of : systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins | First 24 hours post cardiac surgery | 
| Preoperative RV dysfunction | As defined systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins | 30 days before cardiac surgery | 
| Acute kidney injury | defined by KDIGO criteria as creatininemia elevation above > 26 micromol/L during the first 48 hours or +50% during the first week, oliguria with urine output less than 0.5 mL/kg/h during 6 hours. | one week after surgery | 
| Cholestasis | Conjugate bilirubin elevation above 12 mmol/L | one week after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac surgery, Echocardiography, Right ventricular dysfunction, Doppler, Portal vein Doppler, Ventricular function