Right Ventricle-Pulmonary Artery Coupling and Major Morbidity and Operative Mortality After Cardiac Surgery.

Background: The right ventricle-pulmonary artery (RV-PA) coupling ratio provides an assessment of RV function indexed to PA afterload. A low preoperative RV-PA ratio has been associated with increased mortality after transcatheter procedures. In patients undergoing cardiac surgery, we hypothesized that a lower preoperative RV-PA ratio is independently associated with a higher risk of major morbidity and operative mortality (MMOM).

How We Would Use Enhanced Recovery After Cardiac Surgery: What We Would Do for Ourselves During the Perioperative Period.

Enhanced Recovery After Cardiac Surgery (ERACS) programs have grown from their humble beginnings as a "fast-track recovery" pathway that was first described in 1994 and have now evolved into patient-centered, multidisciplinary, multimodal, comprehensive, evidence-based bundles that standardize care and minimize variability throughout the perioperative period. Here, we use a model case, one familiar to most cardiac anesthesiologists, to describe how we would like to be managed using ERACS pathways. These are the same pathways and interventions we use almost daily in our own practices.

Right Ventricle-Pulmonary Artery Coupling in Patients Undergoing Cardiac Interventions.

Purpose Of Review: This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac surgery, cardiac interventions, and congenital heart disease.

Recent Findings: The need for more accessible clinical means of evaluation of RV-PA coupling has driven researchers to investigate surrogates using cardiac MRI, echocardiography, and right-sided pressure measurements in patients undergoing cardiac surgery/interventions, as well as patients with congenital heart disease. Recent research has aimed to validate these alternative means against the gold standard, as well as establish cut-off values predictive of morbidity and/or mortality.