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CARDIOVASCULAR ANESTHESIA

Diastolic Dysfunction is Predictive of Difficult Weaning from Cardiopulmonary Bypass

Francis Bernard, MD^*, André Denault, MD, FRCPC, Denis Babin, MSc, Caroline Goyer, MD, Pierre Couture, MD, FRCPC, André Couturier, MSc, and Jean Buithieu, MD, FRCPC^*

Departments of *Medicine and Cardiology, CHUM, Notre-Dame Hospital; and Department of Anesthesia, Montreal Heart Institute Montreal, Quebec, Canada

Address correspondence and reprint requests to Dr. Denault, Department of Anesthesia, Montreal Heart Institute, 5000 Belanger St. East, Montreal, Quebec H1T 1C8, Canada. Address e-mail to denault{at}videotron.ca

Diastolic function is receiving more attention since echocardiographic measurements were developed and have become widely available. The importance and significance of diastolic dysfunction (DD) observed before cardiac surgery and its relationship with adverse outcomes, such as difficult separation from cardiopulmonary bypass (CPB), have not been fully explored. In this study, we hypothesize that DD can be a predictor for the need of inotropic support to successfully separate from CPB. Ninety-two consecutive patients underwent surgery during the study period. Twenty-six patients were excluded. From the remaining 66 patients, 52 had coronary artery bypass grafting alone and 14 combined procedures, valvular surgery, and reoperations (redo). Systolic and diastolic function was evaluated by two experts blinded as to the clinical data except for the age. The evaluation of diastolic function was done according to published guidelines. The demographic, echocardiographic, and hemodynamic variables were entered in a logistic regression analysis to determine which variables were independent predictors of difficult separation from CPB and the need for postoperative vasoactive support. DD was present in 20 patients (30%). Patients with DD had lower weight (P = 0.046), less frequent coronary artery bypass grafting alone (P = 0.0004), more myocardial infarction before surgery (P = 0.02), higher regional wall motion score index (P = 0.0002), and larger left ventricle (P = 0.03). Total CPB time (P = 0.004) and ischemic time (P = 0.007) were longer in the DD group. Patients with DD required more frequent inotropic support at the end of surgery (P = 0.006) and up to 12 h after surgery (P = 0.003). Multivariate logistic regression identified female sex, DD, and total CPB time as predictive of difficult weaning and inotropic requirements up to 12 h after surgery.

Implications: Abnormal diastolic filling patterns are frequently observed during cardiac surgery. The data support routine evaluation of diastolic function during echocardiographic cardiac assessment of patients undergoing cardiac surgery.

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