Perioperative management of the vulnerable and failing right ventricle

R C Arora; J K Brown; S Chatterjee; T J Gan; G Singh; M Z Tong; POQI IX Consortium

doi:10.1186/s13741-024-00397-5

Perioperative management of the vulnerable and failing right ventricle

Perioper Med (Lond). 2024 May 16;13(1):40. doi: 10.1186/s13741-024-00397-5.

Authors

R C Arora^{1

2}, J K Brown³, S Chatterjee^{4

5}, T J Gan⁶, G Singh^{7

8}, M Z Tong⁹; POQI IX Consortium

Affiliations

¹ Harrington Heart and Vascular Institute - University Hospitals, Cleveland, OH, USA. rakeshcarora@gmail.com.
² Department of Surgery, Case Western Reserve University, Cleveland, OH, USA. rakeshcarora@gmail.com.
³ Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
⁵ Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
⁶ Division of Anesthesiology and Perioperative Medicine, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
⁸ Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, AB, Canada.
⁹ Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Under recognition combined with suboptimal management of right ventricular (RV) dysfunction and failure is associated with significant perioperative morbidity and mortality. The contemporary perioperative team must be prepared with an approach for early recognition and prompt treatment. In this review, a consensus-proposed scoring system is described to provide a pragmatic approach for expeditious decision-making for these complex patients with a vulnerable RV. Importantly, this proposed scoring system incorporates the context of the planned surgical intervention. Further, as the operating room (OR) represents a unique environment where patients are susceptible to numerous insults, a practical approach to anesthetic management and monitoring both in the OR and in the intensive care unit is detailed. Lastly, an escalating approach to the management of RV failure and options for mechanical circulatory support is provided.

Keywords: Heart failure; Management; Right heart failure; Right ventricle; Scoring system.

Publication types

Review