JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (36)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bernard, F.
Right arrow Articles by Buithieu, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bernard, F.
Right arrow Articles by Buithieu, J.
Related Collections
Right arrow Cardiovascular
Right arrow Surgery
Right arrow Heart
Anesth Analg 2001;92:291-298
© 2001 International Anesthesia Research Society


CARDIOVASCULAR ANESTHESIA

Diastolic Dysfunction is Predictive of Difficult Weaning from Cardiopulmonary Bypass

Francis Bernard, MD*, André Denault, MD, FRCPC{dagger}, Denis Babin, MSc{dagger}, Caroline Goyer, MD{dagger}, Pierre Couture, MD, FRCPC{dagger}, André Couturier, MSc{dagger}, and Jean Buithieu, MD, FRCPC*{ddagger}

Departments of *Medicine and {ddagger}Cardiology, CHUM, Notre-Dame Hospital; and {dagger}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.




This article has been cited by other articles:


Home page
Eur. J. Cardiothorac. Surg.Home page
A. A. Alsaddique
Recognition of diastolic heart failure in the postoperative heart
Eur. J. Cardiothorac. Surg., December 1, 2008; 34(6): 1141 - 1148.
[Abstract] [Full Text] [PDF]


Home page
PerfusionHome page
A Schumacher, E. Khojeini, and D. Larson
ECHO parameters of diastolic dysfunction
Perfusion, September 1, 2008; 23(5): 291 - 296.
[Abstract] [PDF]


Home page
Anesth. Analg.Home page
J. Frogel, L. Soranno, and T. Humphrey
Aortic Insufficiency Confounding Transesophageal Echocardiograph Assessment of Left Ventricular Diastolic Function
Anesth. Analg., February 1, 2008; 106(2): 409 - 411.
[Full Text] [PDF]


Home page
SEMIN CARDIOTHORAC VASC ANESTHHome page
B. Qizilbash, P. Couture, and A. Denault
Impact of Perioperative Transesophageal Echocardiography in Aortic Valve Replacement
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 288 - 300.
[Abstract] [PDF]


Home page
Ann. Thorac. Surg.Home page
T. Patila, S. Kukkonen, A. Vento, V. Pettila, and R. Suojaranta-Ylinen
Relation of the Sequential Organ Failure Assessment Score to Morbidity and Mortality After Cardiac Surgery
Ann. Thorac. Surg., December 1, 2006; 82(6): 2072 - 2078.
[Abstract] [Full Text] [PDF]


Home page
Br J AnaesthHome page
R. Salem, A. Y. Denault, P. Couture, S. Belisle, A. Fortier, M.-C. Guertin, M. Carrier, and R. Martineau
Left ventricular end-diastolic pressure is a predictor of mortality in cardiac surgery independently of left ventricular ejection fraction
Br. J. Anaesth., September 1, 2006; 97(3): 292 - 297.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
A. Y. Denault, M. Chaput, P. Couture, Y. Hebert, F. Haddad, and J.-C. Tardif
Dynamic right ventricular outflow tract obstruction in cardiac surgery
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 43 - 49.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
Y. Shi, A. Y. Denault, P. Couture, A. Butnaru, M. Carrier, and J.-C. Tardif
Biventricular diastolic filling patterns after coronary artery bypass graft surgery
J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1080 - 1086.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
L. Groban and S. Y. Dolinski
Transesophageal Echocardiographic Evaluation of Diastolic Function
Chest, November 1, 2005; 128(5): 3652 - 3663.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
A. D. Maslow, M. M. Regan, C. Schwartz, A. Bert, and A. Singh
Inotropes Improve Right Heart Function in Patients Undergoing Aortic Valve Replacement for Aortic Stenosis
Anesth. Analg., April 1, 2004; 98(4): 891 - 902.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. Hache, A. Denault, S. Belisle, D. Robitaille, P. Couture, P. Sheridan, M. Pellerin, D. Babin, N. Noel, M.-C. Guertin, et al.
Inhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 642 - 649.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan
Intraoperative Echocardiography
Card. Surg. Adult, January 1, 2003; 2(2003): 283 - 314.
[Full Text]


Home page
Anesth. Analg.Home page
A. D. Maslow, M. M. Regan, P. Panzica, S. Heindel, J. Mashikian, and M. E. Comunale
Precardiopulmonary Bypass Right Ventricular Function Is Associated with Poor Outcome After Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Systolic Dysfunction
Anesth. Analg., December 1, 2002; 95(6): 1507 - 1518.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
R. Lattik, P. Couture, A. Y. Denault, M. Carrier, F. Harel, J. Taillefer, and J.-C. Tardif
Mitral Doppler Indices Are Superior to Two-Dimensional Echocardiographic and Hemodynamic Variables in Predicting Responsiveness of Cardiac Output to a Rapid Intravenous Infusion of Colloid
Anesth. Analg., May 1, 2002; 94(5): 1092 - 1099.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
J. Poelaert, A. Denault, F. Bernard, and P. Couture
Diagnosis of Diastolic Dysfunction: Importance of Spectral Doppler Imaging * Response
Anesth. Analg., April 1, 2002; 94(4): 1043 - 1045.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. R. Graham, R. K. Warrian, L. G. Girling, L. Doiron, G. R. Lefevre, M. Cheang, and W. A. C. Mutch
Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass
J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 63 - 71.
[Abstract] [Full Text] [PDF]




Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2001 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2001 by the International Anesthesia Research Society.