The effects of hypothermia on human left ventricular contractile function during cardiac surgery

We investigated the interaction of heart rate (HR), temperature and contractility using a validated load independent method.

Temperature manipulation is an integral part of cardiac surgery, and postoperative hypothermia is extremely common. Myocardial contraction is a series of enzymatic and physico-chemical reactions that may be differentially affected by temperature.

Ten patients undergoing coronary artery bypass grafting were studied during moderately hypothermic cardiopulmonary bypass. After conduit procurement and heparinization but before grafting, the patient was placed on cardiopulmonary bypass and rewarmed to 37 degrees C, and the left ventricle (LV) was instrumented with a conductance catheter allowing continuous pressure and volume measurement. The LV pressure volume relationship was examined to assess the contractility at 37, 35, 33 and 31 degrees C, with fixed atrial pacing (100 beats/min) in five patients and at 80 and 120 beats/min, at 33 and 37 degrees C in five patients.

At a HR of 100 beats/min, lower temperature resulted in a highly significant decrease in maximal elastance (100% at 37 degrees C, 29 +/- 3.5% at 31 degrees C, p < 0.0001). At 37 degrees C, increasing HR increased contractility (80 beats/min 100%, 120 beats/min 205.9%, p = 0.0021); however, at 33 degrees C contractility fell with increasing HR (80 beats/min 100%, 120 beats/min, 53.7%, p = 0.0014).

At normothermia LV contractility has a direct relationship with HR. In hypothermic conditions this relationship inverses. Clinical strategies maintaining higher HRs at colder temperatures result in reduced contractility. These factors are important in the management of cardiac surgical patients.