Intraoperative right ventricular end-systolic pressure–volume loop analysis in patients undergoing cardiac surgery: A proof-of-concept methodologyCentral MessagePerspective
Vahid Kiarad, MD, MPH,
Feroze Mahmood, MD, FASE,
Mona Hedayat, MD,
Rayaan Yunus, MPH,
Alina Nicoara, MD,
David Liu, MD,
Louis Chu, MD,
Vankatachalam Senthilnathan, MD,
Masashi Kai, MD,
Kamal Khabbaz, MD
Affiliations
Vahid Kiarad, MD, MPH
Department of Anesthesiology, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Feroze Mahmood, MD, FASE
Department of Anesthesiology, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Mona Hedayat, MD
Department of Anesthesiology, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Rayaan Yunus, MPH
Department of Anesthesiology, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Alina Nicoara, MD
Department of Anesthesiology, Duke University Hospital, Durham, NC
David Liu, MD
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Louis Chu, MD
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Vankatachalam Senthilnathan, MD
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Masashi Kai, MD
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
Kamal Khabbaz, MD
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Address for reprints: Kamal Khabbaz, MD, Associate Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Boston, MA 02215.
Background: Perioperative right ventricular (RV) dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to demonstrate proof of concept in generating intraoperative RV pressure–volume (PV) loops and conducting an end-systolic PV relationship (ESPVR) analysis using data obtained from routinely used intraoperative monitors. Methods: Adult patients undergoing cardiac surgery with the placement of a pulmonary artery catheter (PAC) between May 2023 and March 2024 were included prospectively. The PV loops were generated using 3-dimensional echocardiographic RV volume data and continuous RV pressure data obtained from a PAC. The volume–time and pressure–time curves were digitized using the semiautomatic WebPlotDigitizer program and synchronized to reconstruct an RV PV loop and analyze ESPVR using the previously validated single-beat method. Results: Intraoperative RV PV loops were generated for 25 patients, including 17 patients with preserved RV systolic function (group 1) and 8 patients with reduced systolic function (group 2). Mean Ees, Ea, and Ees/Ea ratio were 0.63 ± 0.25 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 1.0 8 ± 0.31 mm Hg/mL, respectively, by the Pmax method and 0.56 ± 0.32 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 0.91 ± 0.21 mm Hg/mL, respectively, by the V0 method. Group 1 had a significantly higher Ees compared to group 2 regardless of the calculation method and a larger Ees/Ea ratio calculated by the V0 method. Conclusions: It is clinically feasible to derive RV PV loops from routine hemodynamic and echocardiographic data. With further validation and technological support, this can be a potential real-time intraoperative RV function monitoring tool.
