Postcardiotomy right ventricular failure

Postcardiotomy right ventricular failure (also referred to as postcardiotomy right heart failure or post-cardiac surgery right ventricular dysfunction) is a serious complication that occurs following open-heart surgery (cardiotomy). It is characterized by the inability of the right ventricle to adequately pump blood into the pulmonary circulation after a cardiac surgical procedure. This condition can develop after various types of cardiac operations, including coronary artery bypass grafting, valve surgery, heart transplantation, or implantation of a left ventricular assist device. The right ventricle becomes unable to maintain sufficient cardiac output, leading to systemic venous congestion and inadequate blood flow to the lungs. Key clinical features include low cardiac output syndrome, systemic hypotension, elevated central venous pressure, peripheral edema, hepatic congestion, renal dysfunction, and signs of end-organ hypoperfusion. Patients may present with hemodynamic instability requiring vasopressor and inotropic support in the immediate postoperative period. Treatment involves a combination of pharmacological and mechanical support strategies. Inotropic agents (such as milrinone and dobutamine), vasopressors, and pulmonary vasodilators (including inhaled nitric oxide and prostacyclins) are commonly used to optimize right ventricular function and reduce pulmonary vascular resistance. In refractory cases, mechanical circulatory support devices such as right ventricular assist devices (RVAD) or extracorporeal membrane oxygenation (ECMO) may be required. The prognosis depends on the underlying cause, the severity of right ventricular dysfunction, and the timeliness of intervention. This condition carries significant morbidity and mortality and remains a challenging clinical scenario in postoperative cardiac care.

Age of Onset

Variable

Can begin at different ages, from infancy through adulthood

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