RIght VEntricle Response to Major Lung Resection in VATS and Robotic Surgery (the RIVER-2 Study)
Major pulmonary resection is associated with high postoperative morbidity and mortality, mainly due to cardiorespiratory complications. Right ventricular (RV) function is closely related to pulmonary artery pressure and tone, and it is particularly sensitive to changes in afterload. An increase in RV flow resistance can lead to acute RV dilation and reduced left ventricular compliance, potentially progressing to cardiogenic shock. In a previous study (RIVER), it was observed that increased afterload following open thoracic surgery reduces RV function, although this impairment remains subclinical. The aim of this study is to investigate the same parameters in patients with severe cardiovascular comorbidities undergoing pulmonary resection via minimally invasive approaches (VATS and robotic surgery) compared to open thoracotomy.
• Adult patients aged ≥18 years
• Scheduled for elective lobectomy (or bilobectomy) via minimally invasive or open thoracic surgery
• Ability to provide written informed consent at the time of hospital admission
• Moderate to high cardiopulmonary risk, defined by at least one of the following criteria:
‣ ASA physical status classification 3
⁃ Predicted postoperative FEV1 \<60% and 6-minute walk test \<400 m or cardiopulmonary exercise test \<20 ml/kg/min
⁃ DASI index \<34
⁃ RCRI \>2
⁃ Coronary artery disease
⁃ Heart failure
⁃ Right ventricular systolic dysfunction (TAPSE \<17 mm and/or S' wave on TDI \<10 cm/s)
⁃ Left ventricular systolic dysfunction (EF \<55%)