Impact of Right Ventricular Systolic Dysfunction on the Outcome of Coronary Artery Bypass Graft Surgery

We aimed to study the effects of right ventricular systolic dysfunction on the outcome of patients after coronary artery bypass graft surgery (CABG).

This study enrolled 106 patients (age=60.1±10.8 y, 58.5% male) who underwent pure CABG in Tehran Heart Center and had right ventricular systolic dysfunction (RVSD) with tricuspid annular plane systolic excursion (TAPSE)<16. As a control group, 424 patients (age=61.4±9.7 y, 55.7% male) with a history of isolated CABG and preoperative normal right ventricular systolic function (NRVSF) (TAPSE≥16) were selected.  The median follow-up time was 12 months. Death, ICU stay, intubation time, hospital stay, postoperative blood transfusion, pleural effusion, and tamponade were considered adverse outcomes. TAPSE≤14 was considered more severe RVSD.

In-hospital mortality was significantly higher in the RVSD group than in the NRVSF group (3.8% vs 0.7%; P=0.032). No significant effect of RVSD on ventilation time, hospital length of stay, ICU length of stay, postoperative blood transfusion, tamponade, and pleural effusion was found. The effect of RVSD on overall survival was not significant (P=0.096); however, there was a significantly higher rate of cardiac death in the RVSD group (P=0.017).  Overall survival was better in the NRVSF group than in the group with more severe RVSD as a trend (P=0.076).  The mean values of ventilation time, hospital length of stay, and ICU length of stay were significantly higher among patients with TAPSE≤14 than those with TAPSE≥16.

Preoperative RVSD was associated with increased in-hospital and cardiac mortality in patients undergoing pure CABG, and higher RVSD is a potent risk factor for adverse outcomes following CABG. (Iranian Heart Journal 2022; 23(2): 16-25)