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CARDIOVASCULAR ANESTHESIA

Perioperative Assessment of Left Ventricular Function by Pressure-Volume Loops Using the Conductance Catheter Method

Sven A. F. Tulner, MD^*,, Robert J. M. Klautz, MD PhD, Gerda L. van Rijk-Zwikker, MD PhD, Frank H. M. Engbers, MD, Jeroen J. Bax, MD PhD^*, Jan Baan, PhD^*, Ernst E. van der Wall, MD PhD^*, Robert A. Dion, MD, and Paul Steendijk, PhD^*

Departments of *Cardiology, Cardio-Thoracic Surgery, and Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands

Address correspondence and reprint requests to Paul Steendijk, PhD, Leiden University Medical Center, Department of Cardiology, PO Box 9600, 2300 RC Leiden, The Netherlands. Address e-mail to p.steendijk{at}lumc.nl

Interpretation of perioperative measurements of cardiac function during cardiac surgery is complicated by changes in loading conditions induced by anesthesia, cardiopulmonary bypass (CPB), and the surgical procedure itself. Quantification of left ventricular (LV) function by pressure-volume relations as obtained by the conductance catheter would be advantageous because load-independent indices can be determined. Accordingly, we evaluated methodological aspects of the conductance-catheter technique and documented LV function before and after CPB in eight patients undergoing coronary artery bypass grafting. LV pressure-volume loops by transesophageal echocardiography-guided transaortic application of the conductance catheter were obtained at steady-state and during preload reduction by temporary occlusion of the inferior cava. All patients remained hemodynamically stable, and no complications occurred. Complete data were acquired within 15 min before and after CPB. Cardiac output (5.2 ± 1.3 L/min to 6.0 ± 1.4 L/min) and LV ejection fraction (46% ± 17% to 48% ± 19%) did not change, but end-diastolic pressure increased significantly after CPB (8 ± 2 mm Hg to 16 ± 7 mm Hg; P < 0.05). Load-independent systolic indices remained constant (end-systolic elastance: 1.31 ± 1.20 mm Hg/mL to 1.13 ± 0.59 mm Hg/mL). Diastolic function changed significantly after CPB, as the relaxation time constant decreased from 64 ± 6 ms to 52 ± 5 ms (P < 0.05) and the chamber stiffness constant increased from 0.016 ± 0.014/mL to 0.038 ± 0.016/mL (P < 0.05). We conclude that the conductance catheter method provides detailed data on perioperative myocardial function and may be useful for evaluating the effects of new surgical and anesthetic procedures.

IMPLICATIONS: Pressure-volume loops provide on-line quantification of intrinsic systolic and diastolic myocardial function in a load-independent fashion. This study shows the feasibility of perioperative pressure-volume analysis by use of the conductance-catheter method. This method provides detailed data about the immediate effects of surgery and may be used to evaluate complex cardiac procedures.

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