Right Ventricle Function After Major Right Lung Resection

Study Overview
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Brief Summary
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Major lung resection is associated with high post-operative morbidity and mortality and significant long-term decreased functional capacity, especially due to cardiorespiratory complications. RV (Right Ventricle) ejection, pulmonary artery pressure and tone are tightly coupled. The RV is exquisitely sensitive to changes in afterload. When pulmonary vascular reserve is compromised RV ejection may be also compromised, increasing right atrial pressure and limiting maximal cardiac output. Acute increase in RV outflow resistance, as may occur with acute pulmonary embolism will cause acute RV dilatation and, by ventricular interdependence, markedly decreased LV (Left Ventricle) compliance, rapidly spiraling to acute cardiogenic shock and death. Most of the studies on RV function after lung resection are small and have found different results, and sometimes conflicting findings. As far as the investigators know, there are no data on the incidence of the RV dysfunction after major lung resection (pneumonectomy/bilobectomy) and it's not clear if there is some direct association between the RV dysfunction and post-operative complications. If so, early detection of RV dysfunction after major lung resection could provide the opportunity for interventional therapy with consequent possible improvement of these patients' prognosis.

Detailed Description
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The aim of this study is to identify the incidence of early RV systolic dysfunction (defined as Tricuspid Annular Plane Systolic Excursion (TAPSE) < 17 cm, S' (TDI) < 10 cm/s) and estimate the RV-PA (Right Ventricle-Pulmonary Artery) coupling as indicated by Guazzi et all. (TAPSE/PAPs ratio, where PAPs is the Systolic Pulmonary Artery Pressure) after major lung resection (bilobectomy and pneumonectomy) using echocardiography, and to assess if these modifications (RV dysfunction and RV-PA coupling) may be associated with post-operative cardiopulmonary complications occurring during the hospitalization period. Investigators also intend to evaluate if these changes are associated with impaired functional capacity at 3 months after surgery.

Official Title
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Early Peri-operative Right Ventricle Dysfunction Following Major Lung Resection

Conditions
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Right Ventricular Dysfunction, Pneumonectomy; Status

Intervention / Treatment
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* Diagnostic Test: Echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults patients undergoing right pneumonectomy Adults patients undergoing pulmonary bilobectomy Exclusion Criteria: Left pneumonectomy (it will not permit TTE postoperatively) Completion pneumonectomy Patients suffering from any myocardial disease Preceding Pulmonary Embolism Pregnancy Potential pregnancy Patients enrolled into another trial

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients submitted to right pneumonectomy or bi-lobectomy<br>Consecutive, elective surgical patients submitted to right pneumonectomy or bi-lobectomy | Diagnostic Test: Echocardiography<br>* Before and after right pneumonectomy or bi-lobectomy patients will receive echocardiography<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of right ventricle disfunction | Incidence of early RV systolic dysfunction (defined as TAPSE < 17 mm, S' (TDI) < 10 cm/s) and estimate the RV-PA coupling as indicated by Guazzi et al. (TAPSE/PAPs ratio mm/mmHg) after major lung resection (bilobectomy and pneumonectomy) using echocardiography. | Immediately after the awakening from general anesthesia (Day 0) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-operative outcome | Pulmonary failure may be associated with post-operative pulmonary embolism | Within 3rd post-operative day | 
| Right ventricle failure | RV dysfunction and RV-PA uncoupling may be associated with post-operative pulmonary hypertension occurring during the hospitalization period. | Within 3rd post-operative day | 
| Post-operative quality of life | DASI questionnaire | 3 months, post-operatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Right Ventricle Disfunction, Pneumonectomy, Echocardiography