Related Experiment Videos
Changes in systolic and diastolic ventricular function with cold cardioplegic arrest in man. The Multicenter Study of
1Department of Anesthesiology, University of California, San Francisco.
Insights
Cold cardioplegic cardiac arrest impairs left ventricular systolic and diastolic function after surgery. This dysfunction can be measured using volume conductance and micromanometer techniques, highlighting risks in cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
- Hemodynamics
Background:
- Coronary artery bypass graft surgery commonly uses aortic cross-clamping and cardioplegic arrest.
- Ventricular dysfunction post-cardioplegic arrest is a significant factor in perioperative morbidity and mortality.
- This study quantifies left ventricular systolic function changes due to cold cardioplegia.
Purpose of the Study:
- To assess the impact of cold cardioplegia on left ventricular systolic and diastolic function.
- To quantify changes in cardiac function using specific hemodynamic parameters.
- To evaluate the utility of volume conductance and micromanometer catheters in measuring these changes.
Main Methods:
- Thirty patients undergoing coronary artery bypass graft surgery were studied.
- Volume conductance and micromanometer catheters were inserted into the left ventricles.
- Left ventricular systolic function was assessed using preload reduction to measure Ees, EdP/dtMax-EDV, EPLRSW, Eed, and ENegdP/dtMax-EDV.
Main Results:
- The slope of the end-systolic pressure-volume relationship (Ees) significantly decreased from 4.32 +/- 2.94 prebypass to 2.52 +/- 1.06 mmHg/mL postbypass.
- Other measures of systolic and diastolic function were also assessed.
- Data indicates a decline in ventricular performance after cardioplegic arrest.
Conclusions:
- Cold cardioplegic cardiac arrest is linked to postbypass systolic and diastolic ventricular dysfunction.
- Volume conductance and micromanometer measurements can effectively quantify this dysfunction.
- Findings underscore the physiological consequences of cardioplegic arrest in cardiac surgery.
Introduction:
Most of the cardiac surgery done today is performed with aortic cross-clamping and cardioplegic arrest. Despite improvements in cardioplegic techniques, ventricular dysfunction following cardioplegic arrest is a major cause of perioperative morbidity and mortality. This experiment will quantify the changes in left ventricular systolic function with cold cardioplegia. Four measures of cardiac function will be assessed with a volume conductance catheter.
Methods And Results:
Thirty patients undergoing coronary artery bypass graft surgery had volume conductance and micromanometer catheters placed in their left ventricles. Preload reduction was used to measure Ees (the slope of the end-systolic pressure-volume relationship), EdP/dtMax-EDV (slope of dP/dtMax end-diastolic volume relationship), EPLRSW (slope of stroke work end-diastolic volume relationship), Eed (slope of the end-diastolic pressure-volume relationship), and ENegdP/dtMax-EDV (slope of the negative dP/dtMax end-diastolic volume relationship). Ees decreased from 4.32 +/- 2.94 prebypass to 2.52 +/- 1.06 mmHg/mL postbypass.
Conclusion:
Cold cardioplegic cardiac arrest is associated with postbypass systolic and diastolic ventricular dysfunction, which can be quantitated by volume conductance and micromanometer based measurements.