A retrospective cohort study on the intraoperative monitoring of right ventricular function in tumors involving the inferior Vena Cava.

Abstract

Background: This study aimed to evaluate right ventricular function during surgery for tumor thrombus in the inferior vena cava (IVC) and/or right atrium (RA) using intraoperative transesophageal echocardiography (TEE). It also sought to provide evidence supporting the monitoring and hemodynamic management of the right heart by examining the relationship between the use of vasoactive drugs and changes in right ventricular function in patients with RA invasion versus those with thrombus limited to the IVC after tumor resection.

Methods: A retrospective analysis was conducted on patients who underwent IVC tumor resection at Peking University People's Hospital between June 201 3and October 2021. The collected data included patient demographics, right ventricular function parameters (measured by intraoperative TEE), perioperative use of vasoactive drugs, and postoperative hemodynamics. Patients were categorized into two groups: RA (tumor invading the right atrium) and IVC (tumor confined to the IVC).

Results: The study included 15 patients, 11 of whom (73.3%) had RA invasion. Both fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) showed significant improvement postoperatively. The postoperative right ventricular end-diastolic volume (RVEDV) was larger in the RA group, who also experienced longer hospital stays.

Conclusions: Postoperative right ventricular systolic function improved in patients with IVC thrombus. However, RA invasion was associated with longer recovery times, underscoring the need for targeted management to prevent right ventricular failure, particularly following relief of IVC obstruction.