Influence of passive leg elevation on the right ventricular function in anaesthetized coronary patients

Abstract

Correspondence: Massimo Bertolissi, bertolissi@rodax.net ∆p SSP/RVSP = pressure gradient between systolic systemic pressure and right ventricular systolic pressure; ∆p DSP/mRVDP = pressure gradient between diastolic systemic pressure and the mean right ventricular diastolic pressure (the mean value between diastolic and end diastolic right ventricular pressures); PLE = passive leg elevation; RVEDVI = right ventricular end diastolic volume index; RVED V/P = right ventricular end diastolic volume/pressure ratio; RVEF = right ventricular ejection fraction; RVESVI = right ventricular end systolic volume index. AbstractIntroduction: The aim of the present study was to evaluate the haemodynamic effects of passive leg elevation on the right ventricular function in two groups of patients, one with a normal right ventricular ejection fraction (RVEF) and one with a reduced RVEF. Methods: Twenty coronary patients undergoing elective coronary artery bypass grafting surgery were studied by a RVEF pulmonary artery catheter. The haemodynamic data reported were collected before the induction of anaesthesia (time point 1), just before (time point 2) and 1 min (time point 3) after the legs were simultaneously raised at 60°, and 1 min after the legs were lowered (time point 4). The patients were divided into two groups: group A, with preinduction RVEF > 45%; and group B, with preinduction RVEF < 40%. Results: In group A (n = 10), at time point 3 compared with time point 2, the heart rate significantly decreased (from 75 ± 10 to 66 ± 7 beats/min). The right ventricular end diastolic volume index (from 105 ± 17 to 133 ± 29 ml/m 2 ), the right ventricular end systolic volume index (from 61 ± 13 to 77 ± 24 ml/m 2 ), the systolic systemic arterial/right ventricular pressure gradient (from 93 ± 24 to 113 ± 22 mmHg) and the diastolic systemic arterial/right ventricular pressure gradient (from 58 ± 11 to 66 ± 12 mmHg) significantly increased. Also in group A, the cardiac index did not significantly increase (from 3.28 ± 0.6 to 3.62 ± 0.6 l/min/m 2 ), the RVEF was unchanged, and the right ventricular end diastolic volume/pressure ratio (RVED V/P) did not significantly decrease (from 48 ± 26 to 37 ± 13 ml/mmHg). In group B (n = 6) at the same time, the heart rate (from 72 ± 15 to 66 ± 12 beats/min), the right ventricular end diastolic volume index (from 171 ± 50 to 142 ± 32 ml/m 2 ) and the RVED V/P (from 71 ± 24 to 39 ± 7 ml/mmHg) significantly decreased. The cardiac index and the diastolic systemic arterial/right ventricular pressure gradient were unchanged in group B, while the RVEF and the systolic systemic arterial/right ventricular pressure gradient did not significantly increase, and the right ventricular end-systolic volume index did not significantly decrease. All results are expressed as mean ± standard deviation. Conclusions: We conclude that passive leg elevation caused a worse condition in the right ventricle of group B because, with stable values of cardiac index, of systolic systemic arterial/right ventricular pressure gradie...

To identify normovolemia in humans: The stroke volume response to passive leg raising vs. head‐down tilt

“…In contrast, PLR evoked an acute increase in SV with the increase withheld throughout the 10 min period simultaneously with a decrease in TPR. This is in agreement with studies in patients showing increased SV and CO within minutes (Bertolissi et al, 2003;Boulain et al, 2002;Paelinck et al, 2003;Schrijen et al, 1991), whereas CO tends to decrease from the first minute or remain similar to baseline when exceeding 5 min evaluation at an elevated SV (Boulain et al, 2002;Schrijen et al, 1991). Thus, SV seems to be sensitive to evaluate the changes in CBV.…”

Passive Leg Raising Correlates with Future Exercise Capacity after Coronary Revascularization

“…How stroke volume responds to PLR depends on the Frank-Starling mechanism, including cardiac contractility and preload [ 3 ]. Bertolissi et al further confirmed that cardiac index is unchanged during PLR in those with reduced right ventricular ejection fraction [ 9 ]. Moreover, PLR may also identify impairment of diastolic functional reserve during exercise in patients with abnormal myocardial relaxation [ 10 ].…”

The Effect of Induction of Anesthesia in the Leg-Elevation Position and Head-Down Position Versus Supine Position on the Incidence of Post-Induction Hypotension in Non-Cardiac Surgery: A Randomized Controlled Trial

“…The head-down position was reported to be effective in the management of post-induction hypotension during cardiac surgery [19]. On the other hand, some reports showed that neither the leg-elevation position [20] nor the head-down position [21] improved the hemodynamic profile in cardiac surgery patients. No studies to the best of our knowledge had evaluated the hemodynamic effects of the two study positions in non-cardiac surgery.…”