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Thorac Cardiovasc Surg 2003; 51(6): 301-305
DOI: 10.1055/s-2003-45427
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

Cardiopulmonary Bypass impairs Left Ventricular Function determined by Conductance Catheter Measurement

T.  Aybek1 , M.  F.  Kahn1 , S.  Dogan1 , U.  Abdel-Rahman1 , S.  Mierdl2 , P.  Kessler2 , G.  Wimmer-Greinecker1 , A.  Moritz1
  • 1Department of Thoracic and Cardiovascular Surgery
  • 2Department of Anesthesiology, Intensive Care and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt, Germany
This paper was presented at the 31th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery in Leipzig, February 17-20, 2002
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Publication History

Received August 8, 2003

Publication Date:
11 December 2003 (online)

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Abstract

Objective: Postoperative cardiac depression is attributed to ischemia and the effects of cardiopulmonary bypass (CPB). To evaluate the effect of CPB alone on postoperative left ventricular (LV) dysfunction, we used a conductance catheter to determine the LV performance by pressure-volume relation before and after CPB. Methods: Twenty-two 3-week-old piglets underwent sternotomy and normothermic CPB for one hour. A conductance catheter was placed in the LV cavity. End-systolic pressure-volume relationships (ESPVR), left ventricular end-diastolic pressure (LVEDP) and systemic vascular resistance (SVR) were measured under steady-state conditions before and 15 min after weaning from CPB in group A (n = 11). Group B included 11 piglets without CPB and served as control. Results: There was no difference between groups before initiating CPB. As an indication of depressed LV function, the ESPVR slope (mmHg/ml) was significantly lower in group A after weaning from CPB than in group B (1.69 ± 0.5 vs. 1.86 ± 0.55; p = 0.008). In group A, peak dP/dtmax index (mmHg/s/m2) decreased markedly (1596 ± 339 vs. 2045 ± 206; p = 0.03), while LVEDP (mmHg) was significantly increased (11.7 ± 2.6 vs. 5.4 ± 0.9; p < 0.0001). In addition, SVRindex (dyn x s x cm-5/m2) in group A was significantly lower (1407 ± 176 vs. 1677 ± 313; p < 0.0001) than in group B. Conclusion: Using the very sensitive conductance catheter technique in a pig model, we could show that CPB leads to a significant depression of LV contractility and elastance even without ischemic arrest.

Key words

Cardiopulmonary bypass - conductance catheter - left ventricular function - myocardial contractility

References

  • 1 Taylor K M. SIRS - The systemic inflammatory response syndrome after cardiac operations.  Ann Thorac Surg. 1996;  61 (6) 1607-1608
    CrossrefPubMedGoogle Scholar
  • 2 Kirklin J K. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass.  Ann Thorac Surg. 1991;  51 (4) 529-531
    PubMedGoogle Scholar
  • 3 Taggert D P, Sundaram S, McCartne C. et al . Endotoxemia, complement and white blood cell activation in cardiac surgery: a randomised trial of laxatives and pulsatile perfusion.  Ann Thorac Surg. 1994;  57 376
    PubMedGoogle Scholar
  • 4 Kirklin J K, Westaby S, Blackstone E H. et al . Complement and the damaging effects of cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1983;  86 845
    PubMedGoogle Scholar
  • 5 Pugsley W, Klinger L, Paschlis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neurophysiological functioning.  Stroke. 1994;  25 1393
    PubMedGoogle Scholar
  • 6 Baan J, Aouw Jong T T, Kerkhof P LM. et al . Continuous stroke volume and cardiac output from intra-ventricular dimensions obtained with impedance catheter.  Cardiovasc Res. 1981;  15 328-334
    PubMedGoogle Scholar
  • 7 Dworkin G H, Abd-Elfattah A S, Yeh T , Wechsler A S. Efficacy of recombinant-derived human superoxide dismutase on porcine left ventricular contractility after normothermic global myocardial ischemia and hypothermic cardioplegic arrest.  Circulation. 1990;  82 (5 Suppl) IV359-366
    PubMedGoogle Scholar
  • 8 Schouten V J, Schipperheyn J J, van Rijk-Zwikker G L, Swier G P. Calcium metabolism and depressed contractility in isolated human and porcine heart muscle.  Basic Res Cardiol. 1990;  85 (6) 563-574
    PubMedGoogle Scholar
  • 9 Corin W J, Swindle M M, Spann J F. et al . Mechanism of decreased forward stroke volume in children and swine with ventricular septal defect and failure to thrive.  J Clin Invest. 1988;  82 (2) 544-551
    PubMedGoogle Scholar
  • 10 Setser R, Henson R E 2nd, Allen J S, Fischer S E, Wickline S A, Loren C H. Left ventricular contractility is impaired following myocardial infarction in the pig and rat: assessment by the end-systolic pressure-volume relation using a single-beat estimation technique and cine magnetic resonance imaging.  Ann Biomed Eng. 2000;  28 (5) 484-494
    CrossrefPubMedGoogle Scholar
  • 11 Sasayama S, Asanoi H, Ishizaka S. Continuous measurement of the pressure-volume relationship in experimental heart failure produced by rapid ventricular pacing in conscious dogs.  Eur Heart J. 1992;  13 (Suppl E) 47-51
    PubMedGoogle Scholar
  • 12 Caputo M, Schreuder J, Fino C, Baan J, Alfieri O. Assessment of myocardial performance with ventricular pressure-volume relations: clinical applications in cardiac surgery.  Ital Heart J. 2000;  1 (4) 269-274
    PubMedGoogle Scholar
  • 13 Baan J, van der Velde E T, de Bruin H G, Smeenk G J, Koops J, vanDijk A D, Temmerman D, Senden J, Buis B. Continous measurement of left ventricular volume in animals and humans by conductance catheter.  Circulation. 1984;  70 812-823
    PubMedGoogle Scholar
  • 14 McEntee K, Amory H, Pypendop B. et al . Effects of dobutamine on isovolumic and ejection phase indices of cardiac contractility in conscious healthy dogs.  Res Vet Sci. 1998;  64 (1) 45-50
    CrossrefPubMedGoogle Scholar
  • 15 Kleinman L H, Wechsler A S. Pressure-flow characteristics of the coronary collateral circulation during cardiopulmonary bypass. Effects of ventricualr fibrillation.  Circulation. 1978;  58 (2) 233-239
    PubMedGoogle Scholar
  • 16 Kleinman L H, Yarbrough J W, Symmonds J B, Wechsler A S. Pressure-flow characteristics of the coronary collateral circulation during cardiopulmonary bypass. Effects of hemodilution.  J Thorac Cardiovasc Surg. 1978;  75 (1) 17-27
    PubMedGoogle Scholar
  • 17 Blauth C I, Arnold J V, Schulenberg W E, McCartney A C, Taylor K M. Cerebral microembolism during cardiopulmonary bypass. Retinal microvascular studies in vivo with fluorescein angiography.  J Thorac Cardiovasc Surg. 1988;  95 (4) 668-676
    PubMedGoogle Scholar
  • 18 Welters I, Menges T, Ballesteros M. et al . Thrombin generation and activation of the thrombomodulin protein C system in open heart surgery depend on the underlying cardiac disease.  Thromb Res. 1998;  92 (1) 1-9
    CrossrefPubMedGoogle Scholar
  • 19 Mehlhorn U, Allen S J, Adams D L. et al . Normothermic continuous antegrade blood cardioplegia does not prevent myocardial edema and cardiac dysfunction.  Circulation. 1995;  92 (7) 1940-1946
    PubMedGoogle Scholar
  • 20 Kam P C, Hines L, O'Connor E. Effects of cardiopulmonary bypass on systemic vascular resistance.  Perfusion. 1996;  11 (4) 346-350
    PubMedGoogle Scholar
  • 21 Viitanen A, Salmenpera M, Heinonen J, Hynynen M. Pulmonary vascular resistance before and after cardiopulmonary bypass. The effect of PaCO2.  Chest. 1989;  95 (4) 773-778
    PubMedGoogle Scholar
  • 22 Moser L, Faulhaber J, Wiesner R J, Ehmke H. Predominant activation of endothelin-dependent cardiac hypertrophy by norepinephrine in rat left ventricle.  Am J Physiol Regul Integr Comp Physiol. 2002;  282 (5) R 1389-1394
    PubMedGoogle Scholar

Tayfun Aybek, MD 

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University

Theodor Stern Kai 7

60590 Frankfurt, Germany

Phone: +49 (69) 6301-6141

Fax: +49 (69) 6301-83279

Email: T.Aybek@em.uni-frankfurt.de

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