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Title

Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis
Authors
Licker, Marc
Cikirikcioglu, Mustafa
Inan, Cidgem
Cartier, Vanessa
Kalangos, Afksendiyos
Theologou, Thomas
Cassina, Tiziano
Diaper, John
Published in Critical Care. 2010, vol. 14, no. 3, p. R101
Abstract INTRODUCTION: Left ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis. METHODS: Perioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥ 9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging (TDI) and transmitral flow propagation velocity (Vp). RESULTS: Doppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% (n = 12) and diastolic dysfunction in 84% of patients (n = 89), all of whom had Vp <50 cm/s. During weaning from CPB, 38 patients (40%) required inotropic and/or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age (Odds ratio [OR] = 1.11; 95% confidence interval (CI), 1.01 to 1.22), aortic clamping time (OR = 1.04; 95% CI, 1.00 to 1.08) and Vp (OR = 0.65; 95% CI, 0.52 to 0.81). Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm/s (sensitivity of 72% and specificity 94%). Patients who experienced LV dysfunction presented higher in-hospital mortality (18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044) and an increased incidence of serious cardiac events (81.6 vs. 28.6%, P < 0.001). CONCLUSIONS: This study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm/sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis.
Keywords Aged — Aged, 80 and over — Aortic Valve Stenosis/ surgery — Blood Pressure/ physiology — Cohort Studies — Female — Humans — Male — Middle Aged — Postoperative Complications — Predictive Value of Tests — Preoperative Period — Prospective Studies — Ventricular Dysfunction, Left/ etiology
Identifiers
PMID: 20525242
Full text
Article (Author postprint) - public document Free access
Structures
Faculté de médecine / Section de médecine clinique / Département de chirurgie
Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie et soins intensifs
Research groups Chirurgie cardio-vasculaire (105)
Dysfonctions cardio-pulmonaires et cérébrales (278)
Citation
(ISO format) 		LICKER, Marc et al. Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis. In: Critical Care, 2010, vol. 14, n° 3, p. R101. https://archive-ouverte.unige.ch/unige:20646

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Deposited on : 2012-05-22

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