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Haemodynamics and left ventricular function in heart failure patients: comparison of awake versus intra-operative
Ellen A ten Brinke1, Robert J Klautz, Sven A Tulner
1Department of Cardiology of the Leiden University Medical Center, The Netherlands.
Background:
Heart failure patients are increasingly subjected to surgery. Left ventricular (LV) function is generally assessed in awake patients, but intra-operative LV function is not well studied.
Aim:
To investigate the relation between LV function indices obtained in the catheterization laboratory and those obtained intra-operatively.
Methods:
We enrolled 11 patients with heart failure (NYHA III-IV) scheduled for surgical interventions. LV function was assessed by pressure-volume loops (conductance catheter) during diagnostic catheterizations and intra-operatively under anaesthetized conditions.
Results:
Compared to awake conditions, cardiac output was unchanged intra-operatively but ejection fraction was significantly reduced (-16%) due to increased end-diastolic volume (+13%). Systolic and diastolic LV pressure and afterload (E(A)) dropped significantly (-32%, -22%, -35%, respectively). LV systolic function assessed by dP/dt(MAX) and the end-systolic pressure-volume relation (E(ES)) was significantly reduced (-34%, -35%). LV diastolic stiffness was reduced (-44%). Ventricular-arterial coupling (E(A)/E(ES)) was maintained.
Conclusion:
Intra-operative cardiac output was unchanged compared to awake conditions due to a balance between reduced systolic and improved diastolic function. Ventricular-arterial coupling was maintained by a reduced afterload. Presumably, systolic function and afterload were reduced by anaesthesia, whereas diastolic function improved after pericardectomy. These findings provide insight into the combined effects of anaesthesia, thoracotomy and pericardectomy, and help to interpret LV function measurements in intra-operative conditions.
