Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

Abstract

BackgroundLeft ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting.Materials and methodsLiterature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery.ResultsAlthough diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance.ConclusionDD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory.

Prognostic value of a tissue Doppler-derived index of left ventricular filling pressure on composite morbidity after off-pump coronary artery bypass surgery

“…At the same time, the reduced ability to quickly adapt to the varying loading conditions, which is frequently encountered during the perioperative period, makes the patients more vulnerable to reduced cardiac output or abrupt increase in pulmonary venous pressure and consequent pulmonary oedema. 1 During OPCAB, haemodynamic derangement is accentuated in patients with E/e ′ .15 as a consequence of mechanical heart displacement and often not restored to baseline values. 24 25 All these features would be plausible explanations for our results.…”

“…Diastolic dysfunction involves abnormalities in cardiac filling, which result from a combination of slowed left ventricular (LV) relaxation and increased stiffness, reducing the ability of LV to adapt promptly to changes in loading conditions typical of the perioperative period. 1 As it is one of the first signs of myocardial ischaemia, diastolic dysfunction has received renewed interest in patients undergoing coronary artery bypass graft surgery (CABG) and relatively accurate, non-invasive surrogate measures of LV filling pressure are available. 2 -4 Among the available echocardiographic measures of diastolic function, the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e ′ ) correlates well with LV filling pressure; it is relatively independent of systolic function, rhythm abnormalities, LV hypertrophy, and functional mitral regurgitation compared with conventional measurements with Doppler techniques.…”

Different Roles for Contracture and Calpain in Calcium Paradox-Induced Heart Injury

“…These results are clinically relevant because left ventricular diastolic dysfunction with a normal ejection fraction currently represents 40% to 50% of all heart failure cases [41], 44% to 75% in patients operated for coronary artery disease or aortic stenosis [42]. The left ventricular diastolic dysfunction is linked to an increased incidence of mortality and higher healthcare expenditures.…”

Perioperative Anesthesia Management in Secondary Mitral Regurgitation and Heart Failure

“…In fact, the prevalence of diastolic dysfunction in patients undergoing surgery is signifi cant [ 26 ]. Furthermore, diastolic dysfunction is often associated with systolic dysfunction, LV hypertrophy and PH [ 27 ]. This is important because of deterioration of diastolic dysfunction after CPB, which may persist for several hours [ 28 , 29 ], and because patients with diastolic dysfunction who undergo CABG require more time on CPB, as well as more inotropic support up to 12 h after surgery [ 30 ].…”

“…This is important because of deterioration of diastolic dysfunction after CPB, which may persist for several hours [ 28 , 29 ], and because patients with diastolic dysfunction who undergo CABG require more time on CPB, as well as more inotropic support up to 12 h after surgery [ 30 ]. Taking all this into account, diastolic dysfunction increases the risk for perioperative morbidity and mortality [ 27 ].…”