Biventricular diastolic filling patterns after coronary artery bypass graft surgery

Shi, Yanfen; Denault, André; Couture, Pierre; Butnaru, Ady; Carrier, Michel; Tardif, Jean‐Claude

doi:10.1016/j.jtcvs.2006.01.015

Cited by 59 publications

(44 citation statements)

References 37 publications

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“…We have previously shown that hemodynamic instability after CPB is often the result of various mechanisms. 52 For instance, vasoplegia might not respond well to iMil; however, in patients undergoing coronary revascularization 33 and valvular and complex surgery, 32 RV dysfunction is almost invariably present after CPB. In this study, RV failure was present in more than one-third (13/36) of those patients with difficult or complex separation from CPB.…”

Section: Discussionmentioning

confidence: 99%

“…The examination included a midesophageal four-chamber view, a short-axis transgastric view at the mid-papillary level, and colour flow Doppler imaging of all the valves to detect any significant valvular disease. The RV function was evaluated using the fourchamber view with standard measurements, as previously described 33 and according to published guidelines. 34 The following measurements were obtained: right atrial transverse diameter (RADt), RV dimensions (at the annulus [RVD1], at the mid-portion [RVD2], and from the apex to the RV annular plane [RVD3]), the RV enddiastolic area (RVEDA), the RV end-systolic area (RVESA), the percentage of RV fractional area change (RVFAC) calculated as (RVEDA-RVESA)/RVEDA, and the tricuspid annular plane systolic excursion (TAPSE).…”

Section: Data Collectionmentioning

confidence: 99%

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A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Denault

Bussières

Arellano

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Inhaled milrinone (iMil) has been used for the treatment of pulmonary hypertension (PH) but its efficacy, safety, and prophylactic effects in facilitating separation from cardiopulmonary bypass (CPB) and preventing right ventricular (RV) dysfunction have not yet been evaluated in a clinical trial. The purpose of this study was to investigate if iMil administered before CPB would be superior to placebo in facilitating separation from CPB.Methods High-risk cardiac surgical patients with PH were randomized to receive iMil or placebo after the induction of anesthesia and before CPB. Hemodynamic parameters and RV function were evaluated by means of pulmonary artery catheterization and transesophageal echocardiography. The groups were compared for the primary outcome of the level of difficulty in weaning from CPB. Among the secondary outcomes examined were the reduction in the severity of PH, the incidence of RV failure, and mortality. Results Of the 124 patients randomized, the mean (standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The use of iMil was associated with increases in cardiac output (P = 0.03) and a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless, there was no difference in the combined incidence of difficult or complex separation from CPB between the iMil and control groups (30% vs 28%, respectively; absolute difference, 2%; 95% confidence interval [CI], -14 to 18; P = 0.78). There was also no difference in RV failure between the iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI, -13 to 12; P = 0.94). Mortality was increased in patients with RV failure vs those without (22% vs 2%, respectively; P \ 0.001). Conclusion In high-risk cardiac surgery patients with PH, the prophylactic use of iMil was associated with favourable hemodynamic effects that did not translate into improvement of clinically relevant endpoints. This trial was registered at ClinicalTrials.gov; identifier: NCT00819377. RésuméObjectif La milrinone inhalée est utilisée pour traiter l'hypertension pulmonaire (HP) mais son efficacité, son innocuité et ses effets prophylactiques pour faciliter le sevrage de la circulation extracorporelle (CEC) et prévenir la dysfonction ventriculaire droite (VD) n'ont pas encore été évalués dans le cadre d'une étude clinique. L'objectif de cette étude était d'examiner si la milrinone inhalée avant la CEC serait supérieure à un placebo pour faciliter le sevrage de la CEC. Méthode Des patients de chirurgie cardiaque à risque élevé et souffrant d'HP ont été randomisés à recevoir de la milrinone inhalée ou un placebo après l'induction de l'anesthésie et avant la CEC. Les paramètres hémodynamiques et la fonction VD ont été évalués à l'aide d'un cathéter de l'artère pulmonaire et d'une échocardiographie transoesophagienne. Les groupes ont été comparés selon notre critère d'évaluation principal, soit le niveau de difficulté du sevrage de la CEC. Parmi les critères...

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Denault

Bussières

Arellano

et al. 2016

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

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“…We have also previously reported the effects of anesthesia and surgery on diastolic function [26], but all the animals in the present study were submitted to the same degree of anesthesia. The systolic component of the pulmonary venous flow (S wave) has been shown to correlate well with LV filling pressure and with its change over time [27].…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Reduction by Ivabradine Reduces Diastolic Dysfunction and Cardiac Fibrosis

et al. 2010

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Objectives: To determine if heart rate (HR) reduction with ivabradine (IVA), a selective inhibitor of the pacemaker I_f current, prevents cardiac dysfunction associated with dyslipidemia. Methods: New Zealand White rabbits received either a standard diet, a 0.5% cholesterol-enriched diet only (CD), or a 0.5% CD with IVA (17 mg/kg/day) for 12 weeks. HR, left ventricular (LV) systolic function, diastolic function and LV regional myocardial performance index (MPI) were studied using echocardiography. Histological analysis included cardiac interstitial fibrosis and collagen type I fibers. Plasma levels of angiotensin II and aldosterone were quantified by immunoassays. Results: IVA reduced HR by approximately 11%. IVA improved MPI and attenuated LV diastolic dysfunction (DD) (92% mild and 8% moderate DD with IVA vs. 54% mild and 46% moderate DD in CD group). IVA also reduced atrial fibrosis (p = 0.027), ventricular fibrosis (p = 0.0002) and ventricular collagen type I (p = 0.0042). IVA decreased plasma angiotensin II levels (p = 0.042), and both angiotensin II and aldosterone levels were correlated with HR (p = 0.038 and 0.008). Conclusion: Selective HR reduction with IVA reduces DD and cardiac fibrosis in hypercholesterolemic rabbits. These beneficial effects of IVA support testing pure HR reduction in patients with diastolic heart failure.

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“…The latest echocardiography data from at least 6 months after the surgery were compared with preoperative echocardiography data. 10 We excluded 153 patients who had preoperative atrial fibrillation (n=26), more than grade 2/4 mitral regurgitation (n=46), undetermined diastolic function including sinus tachycardia (n=22), on-pump conversion (n=7), minimal invasive direct CABG (n=9), redo CABG (n=11), perioperative myocardial infarction (n=20), or an emergency operation (n=12). The remaining 1,101 patients who underwent elective isolated OPCAB were enrolled in this study, which was approved by the Institutional Review Board of Yonsei University College of Medicine.…”

Section: Study Populationmentioning

confidence: 99%

“…Usually, ventricular diastolic filling is impaired early after CABG, but improves approximately 6 months later. 10 To minimize this confounding factor, all of the postoperative echocardiography data in our study was from at least 6 months after the operation and before the occurrence of MACCE. Second, the patients with severe LVDD who still had severe LVDD postoperatively were classified in the non-aggravated group (group I).…”

Section: Study Limitationsmentioning

confidence: 99%

Predictors and Clinical Impacts of Aggravated Left Ventricular Diastolic Dysfunction After Off-Pump Coronary Artery Bypass Grafting

Lee

Kim

Joo

et al. 2016

Circ J

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Biventricular diastolic filling patterns after coronary artery bypass graft surgery

Abstract: In patients with preoperative left ventricular diastolic dysfunction, biventricular filling patterns are impaired initially but return to preoperative status 6 months after coronary artery bypass grafting.

Cited by 59 publications

References 37 publications

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Heart Rate Reduction by Ivabradine Reduces Diastolic Dysfunction and Cardiac Fibrosis

Predictors and Clinical Impacts of Aggravated Left Ventricular Diastolic Dysfunction After Off-Pump Coronary Artery Bypass Grafting

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