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Cardiac pump performance in patients who underwent coronary artery bypass grafting
Critical Care volume 10, Article number: P347 (2006)
The measure of ventricular performance, as an independent parameter of cardiovascular function, must be performed by a beat-to beat assessment of systolic function independent of load conditions, and is useful both as an index of contractility and as an index of ventricular functional reserve. We analyzed three different parameters of ventricular performance: the preload adjusted peak power (PAPP) , as an index of contractility; the cardiac cycle efficiency (CCE) , as a measure of ventricular arterial coupling; and the ejection fraction (EF), as an index of global ventricular function.
Materials and methods
Fourteen patients who had undergone elective coronary artery bypass grafting were studied during the operation. All patients had preoperative EF >35%, good function of the cardiac valve and no contraindication to transoesophageal echocardiography (TEE). The arterial pressure was connected to a Pressure Record Analytical Method (PRAM) monitor to continuous measure the stroke volume index (SVI), cardiac cycle efficiency (CCE), and stroke volume variation (SVV) by pressure wave analysis. All the TEE examinations were obtained with a multiplane transesophageal probe (5-MHz probe). PAPP was obtained by the product of the peak systolic aortic pressure and the peak velocity of the aortic blood flow. EF was estimated from the end-diastolic and end-systolic area in the mid-papillary transgastric view. The parameters from PRAM and TEE were recorded simultaneously, and were performed during apnoea, after induction of anaesthesia, and after cardiopulmonary bypass (CPB). In eight patients dobutamine 2.5 μg/kg/min was infused before CPB to assess ventricular reserve.
No significant difference was found between preoperative and postoperative hemodynamic data. There was a good correlation found between PAPPpre vs CCEpre (R 20.80; P < 0.001), PAPPpre vs SVIpre (R 20.95; P < 0.001) and PAPPpre vs EFpre (R 20.92; P < 0.001). The same good correlation was found for postoperative data between PAPPpost vs CCEpost (R2 0.94; P < 0.001), PAPPpost vs SVIpost (R2 0.95; P < 0.01) and PAPPpost vs EFpost (R2 0.90; P < 0.001). There was an improvement of the PAPP value after infusion of dobutamine (2.4 ± 0.9 vs 3.2 ± 0.8) in all eight patients where it was made, but the small samples did not allow statistical analysis in this preliminary study.
The PAPP, CCE and the EF could be used to assess ventricular and ventricular-arterial performance in clinical practice by the new low-invasive monitoring systems.
Amà R, Claessens T, Roosens C, et al.: A comparative study of preload-adjusted maximal and peak power: assessment of ventricular performance in clinical practice. Anaesthesia 2005, 60: 35-40. 10.1111/j.1365-2044.2004.03974.x
Romano SM, et al.: Assessment of cardiac output from systemic arterial pressure in humans. Crit Care Med 2002, 30: 1834-1841. 10.1097/00003246-200208000-00027
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Rossi, A., Romano, S., Sorbara, C. et al. Cardiac pump performance in patients who underwent coronary artery bypass grafting. Crit Care 10, P347 (2006). https://doi.org/10.1186/cc4694
- Coronary Artery Bypass Grafting
- Stroke Volume Variation
- Stroke Volume Index
- Aortic Blood Flow