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Perioperative Right Ventricular Dysfunction: Understanding the Risks and Implications
In this edition of the journal, the Perioperative Quality Initiative (POQI) presents three manuscripts focusing on the physiology, assessment, and management of right ventricular dysfunction (RVD) in the perioperative setting.
Risk Factors for Perioperative RVD
- Pre-existing RVD
- Fluid overload
- Myocardial ischemia
- Pulmonary embolism
- Lung injury
- Mechanical ventilation
- Hypoxia and hypercarbia
- Lung resection
- Medullary reaming and cement implantation
- Cardiac surgery
- Cardiopulmonary bypass
- Heart and lung transplantation
- Left ventricular assist device implantation
There is a lack of systematic attempts to quantify the incidence of perioperative RVD, and existing data is limited by challenges in defining RVD and variations in patient and surgical risk profiles.
Clinical Implications
- Association with atrial arrhythmias
- Prolonged critical care stay following thoracic surgery
- Increased need for inotropic support in revision orthopedic surgery
- Increased critical care requirement and mortality following cardiac surgery
RVD is easily overlooked, leading to underestimation of its contribution to postoperative morbidity. Further study and trial are needed to develop perioperative risk prediction and management strategies.
