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Intraoperative Augmented Rotation and Circumferential Strain Compensate for Reduction of Left Ventricular

Jakob Labus¹, André Foit¹, Oliver Mehler¹

¹Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.

Journal of Cardiothoracic and Vascular Anesthesia

|July 1, 2023

Summary

Coronary artery bypass grafting (CABG) surgery reduces left ventricular (LV) longitudinal function. However, this decline is compensated by improved LV circumferential strain and rotation during surgery.

Keywords:

cardiac surgery left ventricle perioperative course rotation strain analysis twist

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Area of Science:

Cardiology
Cardiac Surgery
Echocardiography

Background:

On-pump coronary artery bypass grafting (CABG) can impair left ventricular (LV) longitudinal function.
Compensatory mechanisms for this functional decline are not well understood.
Myocardial strain analysis offers a detailed view of LV contractile patterns.

Purpose of the Study:

To investigate intraoperative changes in LV contractile patterns using myocardial strain analysis after on-pump CABG.
To identify compensatory mechanisms for the reduction in LV longitudinal function.

Main Methods:

A prospective observational study involving 30 patients undergoing on-pump CABG.
Transesophageal echocardiography was used to assess LV function at three time points: pre-anesthesia, post-cardiopulmonary bypass, and post-sternal closure.
Analysis included LV ejection fraction, global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), apical and basal rotation, and LV twist.

Main Results:

GLS significantly decreased after CABG compared to pre-bypass measurements.
GCS, LV apical rotation, basal rotation, and LV twist significantly improved post-surgery.
No significant changes were observed in LV ejection fraction or GRS during the intraoperative period.

Conclusions:

Intraoperative on-pump CABG leads to a reduction in LV longitudinal function.
This reduction is compensated by improvements in LV circumferential strain and rotation.
Perioperative assessment of strain and rotation provides valuable insights into cardiac mechanics.