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J Thorac Cardiovasc Surg 1998;116:468-472
© 1998 Mosby, Inc.

Surgery for Adult Cardiovascular Disease

Validation of a new intraoperative technique to evaluateload-independent indices of right ventricular performance in patients undergoingcardiac operations

Supported in part by the Garfield Weston Trust (C.I.O.B.) and by theScott Rhodes Research Fund, the Clinical Research Committee of the RoyalBrompton, and the Garfield Weston Trust.

Received for publication Jan 7, 1998. Revisions requested March 16, 1998; revisions received April 17, 1998. Accepted for publication May 13, 1998. Address for reprints: Andrew N. Redington, MD, Department of PediatricCardiology, Royal Brompton National Heart/Lung Institute, Sydney St, Chelsea,London SW3 6NP, United Kingdom.

Background: Assessment of rightventricular performance in the perioperative period is difficult because thereis no generally accepted method of measuring right ventricular volume. We setout to determine whether conductance technology could provide a valuabletechnique for the investigation of intraoperative right ventricular function.
Methods and results: Three validatingstudies were performed in 25 patients undergoing routine coronaryrevascularization. Study 1: The influence of conductance catheter position inthe right ventricle was examined in 10 patients. Insertion of the conductancecatheter through the outflow tract was associated with a larger gain constantand a smaller parallel conductance compared with insertion through the tricuspidvalve. Study 2: The reproducibility of contractility measurements with the useof a conductance catheter was examined in 7 additional patients. Removal andreinsertion of the conductance catheter was not associated with any significantdifference in right ventricular volume or contractile function. Study 3: Rightventricular performance before and after cardiopulmonary bypass was compared in8 additional patients. There was a fall in the slope of the right ventricularpreload recruitable stroke work from 15.6 (3.8) to 11.0 (5.1) mm Hg (P = .01) and an increase in the slope of theend-diastolic pressure-volume relations from 0.05 (0.02) to 0.11 (0.05) mm Hg/mL(P = .001).
Conclusions:The conductance technique can be used to study perioperative changes in rightventricular performance. Insertion of the conductance catheter through theoutflow tract provides stable and reproducible data. There is significantimpairment of right ventricular contractility in the early postoperative period.

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