Thorac cardiovasc Surg 2017; 65(08): 593-600
DOI: 10.1055/s-0036-1572511
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Prevalence, Diagnosis, Perioperative Monitoring and Treatment of Right Ventricular Dysfunction and/or Pulmonary Arterial Hypertension in Cardiac Surgical Patients in Germany—A Postal Survey

Matthias Heringlake
1  Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany
,
Julika Schön
1  Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany
,
Teresa Pliet
1  Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany
,
Nils Haake
2  Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany
,
Alexander Reinecke
2  Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany
,
Marit Habicher
3  Department of Anesthesiology and Intensive Care, Charité University Hospital, Charité Campus Mitte and Virchow Klinikum, Berlin, Germany
,
Michael Sander
3  Department of Anesthesiology and Intensive Care, Charité University Hospital, Charité Campus Mitte and Virchow Klinikum, Berlin, Germany
,
Andreas Markewitz
4  Department of Cardiovascular Surgery, German Armed Forces Central Hospital, Koblenz, Germany
,
Daniel A. Reuter
5  Department of Anesthesiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
,
Heinrich Volker Groesdonk
6  Department of Anesthesiology and Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany
,
Georg Trummer
7  Department of Cardiovascular and Vascular Surgery, Heart Center University Freiburg, Freiburg, Germany
,
Kevin Pilarzyk
8  Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
,
Michael von der Brelie
2  Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany
,
Berthold Bein
9  Department of Anesthesiology and Intensive Care Medicine, St. Georg Hospital, Hamburg, Germany
,
Uwe Schirmer
10  Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

01 November 2015

12 January 2016

Publication Date:
24 February 2016 (eFirst)

Abstract

Background Sparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities.

Methods A postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers. Total 47 of 81 (58%) heart centers returned the questionnaires. The centers reported data on 51,095 patients, and 49.8% of the procedures were isolated coronary artery bypass grafting.

Results Data on the prevalence of preoperative pulmonary hypertension and/or right ventricular dysfunction were not available in 54% and 64.6% of centers. In the remaining hospitals, 19.5% of patients presented right heart dysfunction and 10% pulmonary arterial hypertension. Preoperative echocardiography was performed in only 45.3% of the coronary artery bypass grafting cases. Preoperative pharmacologic treatment of pulmonary hypertension or right ventricular dysfunction with oral sildenafil, inhaled prostanoids, or nitric oxide was initiated in 71% and 95.7% of the centers, respectively. Intra- and postoperative treatment was most frequently accomplished with phosphodiesterase-III inhibitors.

Conclusion The prevalence of preoperative right heart dysfunction and pulmonary arterial hypertension in cardiac surgical patients in Germany seems to be substantial. However, in more than 50% of the patients, no preoperative data on right ventricular function and pulmonary arterial pressure are available. This may lead to underestimation of perioperative risk and inappropriate management of this high-risk population.

Note

This abstract was presented at the annual meeting of the European Association of Cardiothoracic Anesthetists (EACTA) in Barcelona, Spain on June 7th, 2013.


Funding

This work was supported by institutional grants of the Department of Anesthesiology and Intensive Care Medicine, University of Lübeck and the Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany. No external funding source has been involved.