SURGICAL SPECIALITY
Personalising Management of Cardiac Surgery Patients Through Right Heart Biomarkers The field of biomarker discovery has advanced rapidly over past decades. Many cardiovascular biomarkers are available to assist in the management of ischemia and left heart failure. However, perioperative Right Heart (RH) failure remains an underexplored area. We propose ST-2, sST-2 and Gal-3 as potential RH-specific markers to provide rapid, non-invasive insight for personalized, etiology-specific therapy, to be validated in the perioperative setting. Louise Y Sun, Division of Cardiac Anesthesiology, University of Ottawa Heart Institute
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iomarkers were first introduced to clinical practice in the 1980s and have since become a staple of diagnosis and prognosis in many areas of medicine. A variety of biomarkers have been implicated in clinical care and research in the cardiovascular realm. These are used mostly in the diagnosis and evaluation of left heart failure and pulmonary hypertension, with little attention paid to the diagnosis and response to treatment for Right Heart Failure (RHF). The right heart is often overlooked in medical practice, and RHF has especially been poorly understood in the dynamic perioperative setting, where the stakes are higher. We in this article will summarize the importance of the
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A SI A N H O S P I T A L & H EA LT HCA R E M A N AGE M E N T
perioperative RHF and introduce new, non-invasive adjuncts for RHF diagnosis and prognosis in this setting. Why is RHF important?
Medicine and medical research have traditionally focused on diseases of the left heart, where much advance has been made over the past few decades. Progress on RHF has lagged behind that of the left heart, and there are relatively few options for the treatment of RHF. RHF is especially relevant to clinical management and patient outcomes in the perioperative setting. In the setting of cardiac surgery, it contributes highly to end organ complications such as stroke, acute kidney failure and death. It
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is also implicated in poor later survival after cardiac surgery. RHF is especially deadly when occurring in combination with left heart failure. It is much more common in the context of cardiac as compared to non-cardiac surgery, and is most frequent after heart transplantation and implantation of Left Ventricular Assist Devices (LVAD).The prediction and diagnosis of RHF are difficult, and treatment is often challenging in the perioperative setting. Practical challenges
In a broad sense, RHF is defined as the inability of the right heart to support the circulation when preload is optimal. The most common cause of RHF is left
