Bedside Assessment of Right Ventricular Output Lying in Prone Or Supine

Right ventricular failure (RVF) is a common complication to cardiac surgery, which is associated to mortality, kidney failure, stroke, prolonged mechanical ventilation and ICU stay. The right ventricle is particularly vulnerable to an increased afterload. By increasing pulmonary vascular resistance (PVR), atelectasis might mitigate a negative effect on the right ventricle. Recruitment maneuvers have been shown to resolve atelectasis and improve hemodynamics by increasing cardiac output and lowering PVR. However these maneuvers transiently raise airway pressures, which in turn increases right ventricular afterload, a situation often poorly tolerated by patients with RVF. Prone position is used in patients with respiratory failure and has been shown to decrease mortality in patients with ARDS. Prone position decreases atelectasis and moves ventilation dorsally. In ARDS it also seems to mediate beneficial hemodynamic effects such as an increase in cardiac output and a decrease in PVR. The investigators hypothesis is that prone position early after cardiac surgery will increase cardiac output by recruitment of atelectasis and thereby decrease PVR.

Inclusion Criteria: * Scheduled for cardiac surgery using cardiopulmonary bypass Exclusion Criteria: * BMI \>40 * Emergency surgery * Advanced grown-up congenital heart disease * Severe pulmonary disease * Haemodynamic instability requiring Norepinephrine \>0.5mcg/kg/min * Intracardiac shunt * Severe (or worse) tricuspid regurgitation * Any condition which, in the judgement of the investigator, might increase the risk to the patient