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Left ventricular function and chronotropic responses after normothermic cardiopulmonary bypass with intermittent antegrade warm blood cardioplegia in patients undergoing coronary artery bypass grafting

Objective: Recent studies indicate that normothermic cardiopulmonary bypass (CPB) with intermittent antegrade warm blood cardioplegia (IAWBC) may have metabolic and clinical advantages, but limited data exist on its effects on myocardial function. Therefore, we investigated the acute effects of this...

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Published in:European journal of cardio-thoracic surgery 2005-04, Vol.27 (4), p.599-605
Main Authors: Tulner, Sven A.F., Klautz, Robert J.M., Engbers, Frank H.M., Bax, Jeroen J., Baan, Jan, van der Wall, Ernst E., Dion, Robert A.E., Steendijk, Paul
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container_issue 4
container_start_page 599
container_title European journal of cardio-thoracic surgery
container_volume 27
creator Tulner, Sven A.F.
Klautz, Robert J.M.
Engbers, Frank H.M.
Bax, Jeroen J.
Baan, Jan
van der Wall, Ernst E.
Dion, Robert A.E.
Steendijk, Paul
description Objective: Recent studies indicate that normothermic cardiopulmonary bypass (CPB) with intermittent antegrade warm blood cardioplegia (IAWBC) may have metabolic and clinical advantages, but limited data exist on its effects on myocardial function. Therefore, we investigated the acute effects of this approach on systolic and diastolic left ventricular function and on chronotropic responses. Methods: In 10 patients undergoing isolated CABG we obtained on-line left ventricular pressure-volume loops using the conductance catheter before and after normothermic CPB with IAWBC. Steady state and load-independent indices of left ventricular function derived from pressure-volume relations were obtained during right atrial pacing (80–100–120beats/min) to determine baseline systolic and diastolic function and chronotropic responses. Results: The mean time of CPB was 105±36min (median 103, range 60–167min) with a mean aortic cross-clamp time of 75±27min (median 69, range 43–129min). Baseline (80beats/min) end-systolic elastance (EES) did not change after CPB (1.22±0.53 to 1.12±0.28mmHg/ml, P≫0.2), while the diastolic chamber stiffness constant (kED) significantly increased (0.014±0.005 to 0.040±0.007ml−1, P=0.018) and relaxation time constant (τ) significantly decreased (61±3 to 49±2ms, P=0.004). Before CPB, incremental atrial pacing had no significant effects on EES and τ but significant negative effects on kED (0.014±0.005 to 0.045±0.012ml−1, P=0.013). After CPB, atrial pacing had significant positive effects on EES, τ and kED (EES: 1.12±0.28 to 2.60±1.54mmHg/ml, P=0.021; τ: 49±2 to 45±2ms, P=0.009; kED: 0.040±0.007 to 0.026±0.005mmHg, P=0.010), indicating improved systolic and diastolic chronotropic responses. Conclusion: On-pump normothermic CABG with IAWBC preserved systolic function, increased diastolic stiffness, and improved systolic and diastolic chronotropic responses. Normalization of the chronotropic responses post-CPB is likely due to effects of successful revascularization and subsequent relief of ischemia.
doi_str_mv 10.1016/j.ejcts.2004.11.024
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Therefore, we investigated the acute effects of this approach on systolic and diastolic left ventricular function and on chronotropic responses. Methods: In 10 patients undergoing isolated CABG we obtained on-line left ventricular pressure-volume loops using the conductance catheter before and after normothermic CPB with IAWBC. Steady state and load-independent indices of left ventricular function derived from pressure-volume relations were obtained during right atrial pacing (80–100–120beats/min) to determine baseline systolic and diastolic function and chronotropic responses. Results: The mean time of CPB was 105±36min (median 103, range 60–167min) with a mean aortic cross-clamp time of 75±27min (median 69, range 43–129min). Baseline (80beats/min) end-systolic elastance (EES) did not change after CPB (1.22±0.53 to 1.12±0.28mmHg/ml, P≫0.2), while the diastolic chamber stiffness constant (kED) significantly increased (0.014±0.005 to 0.040±0.007ml−1, P=0.018) and relaxation time constant (τ) significantly decreased (61±3 to 49±2ms, P=0.004). Before CPB, incremental atrial pacing had no significant effects on EES and τ but significant negative effects on kED (0.014±0.005 to 0.045±0.012ml−1, P=0.013). After CPB, atrial pacing had significant positive effects on EES, τ and kED (EES: 1.12±0.28 to 2.60±1.54mmHg/ml, P=0.021; τ: 49±2 to 45±2ms, P=0.009; kED: 0.040±0.007 to 0.026±0.005mmHg, P=0.010), indicating improved systolic and diastolic chronotropic responses. Conclusion: On-pump normothermic CABG with IAWBC preserved systolic function, increased diastolic stiffness, and improved systolic and diastolic chronotropic responses. Normalization of the chronotropic responses post-CPB is likely due to effects of successful revascularization and subsequent relief of ischemia.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1016/j.ejcts.2004.11.024</identifier><identifier>PMID: 15784357</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Amsterdam: Elsevier Science B.V</publisher><subject>Aged ; Biological and medical sciences ; Biomarkers - blood ; CABG ; Cardiology. 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Therefore, we investigated the acute effects of this approach on systolic and diastolic left ventricular function and on chronotropic responses. Methods: In 10 patients undergoing isolated CABG we obtained on-line left ventricular pressure-volume loops using the conductance catheter before and after normothermic CPB with IAWBC. Steady state and load-independent indices of left ventricular function derived from pressure-volume relations were obtained during right atrial pacing (80–100–120beats/min) to determine baseline systolic and diastolic function and chronotropic responses. Results: The mean time of CPB was 105±36min (median 103, range 60–167min) with a mean aortic cross-clamp time of 75±27min (median 69, range 43–129min). Baseline (80beats/min) end-systolic elastance (EES) did not change after CPB (1.22±0.53 to 1.12±0.28mmHg/ml, P≫0.2), while the diastolic chamber stiffness constant (kED) significantly increased (0.014±0.005 to 0.040±0.007ml−1, P=0.018) and relaxation time constant (τ) significantly decreased (61±3 to 49±2ms, P=0.004). Before CPB, incremental atrial pacing had no significant effects on EES and τ but significant negative effects on kED (0.014±0.005 to 0.045±0.012ml−1, P=0.013). After CPB, atrial pacing had significant positive effects on EES, τ and kED (EES: 1.12±0.28 to 2.60±1.54mmHg/ml, P=0.021; τ: 49±2 to 45±2ms, P=0.009; kED: 0.040±0.007 to 0.026±0.005mmHg, P=0.010), indicating improved systolic and diastolic chronotropic responses. Conclusion: On-pump normothermic CABG with IAWBC preserved systolic function, increased diastolic stiffness, and improved systolic and diastolic chronotropic responses. 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Vascular system</subject><subject>Cardioplegia</subject><subject>Cardiopulmonary Bypass - methods</subject><subject>Chronotropic response</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Arrest, Induced - methods</subject><subject>Heart Rate</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Left ventricular function</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Pressure-volume relations</subject><subject>Time Factors</subject><subject>Troponin T - blood</subject><subject>Ventricular Function, Left</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNqNkUGP1CAYhhujcdfVX2BiuOitFQql5agbdTWTqMkcNl4IpR8zjC1UoK77E_1XMnbcvXqC5Hve54O8RfGc4Ipgwl8fKjjoFKsaY1YRUuGaPSjOSdfSsqXs-mG-Y4LLVjB8VjyJ8YAx5rRuHxdnpGk7Rpv2vPi9AZPQT3ApWL2MKiCzOJ2sd0i5Ael98M6n4GerUYA4exchImUSBOR8mHzaQ5jyUKswWD8v4-SdCreov51VjOjGpj2yLh2hlPKarE2wC2oAdKPChPrR--FfeoSdVRlHs0o2wxEtboCw89btkPZhVauQdXcbssukPH9aPDJqjPDsdF4U2_fvtpdX5ebzh4-XbzalZgKnkuqhqwVWLdaKU9q1wHolWF8Tw5XRXAgjWFMbAarHvRigNlpwyrGpoQFBL4pXq3YO_scCMcnJRg3jqBz4JUreNrQlgmaQrqAOPsYARs7BTvn9kmB5LFAe5N8C5bFASYjMBebUi5N-6ScY7jOnxjLw8gSoqNVognLaxnuOc44Z6zJXrZxf5v_cXK4BGxP8uouo8D3_ibaNvLr-Jr-8_bT9SkUnOf0DfuzMaw</recordid><startdate>20050401</startdate><enddate>20050401</enddate><creator>Tulner, Sven A.F.</creator><creator>Klautz, Robert J.M.</creator><creator>Engbers, Frank H.M.</creator><creator>Bax, Jeroen J.</creator><creator>Baan, Jan</creator><creator>van der Wall, Ernst E.</creator><creator>Dion, Robert A.E.</creator><creator>Steendijk, Paul</creator><general>Elsevier Science B.V</general><general>Elsevier Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050401</creationdate><title>Left ventricular function and chronotropic responses after normothermic cardiopulmonary bypass with intermittent antegrade warm blood cardioplegia in patients undergoing coronary artery bypass grafting</title><author>Tulner, Sven A.F. ; Klautz, Robert J.M. ; Engbers, Frank H.M. ; Bax, Jeroen J. ; Baan, Jan ; van der Wall, Ernst E. ; Dion, Robert A.E. ; Steendijk, Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-3cd8290a70ca63387e4ba94b21f6afc699f9452f9eab0b9de2fc96360f2e5e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>CABG</topic><topic>Cardiology. Vascular system</topic><topic>Cardioplegia</topic><topic>Cardiopulmonary Bypass - methods</topic><topic>Chronotropic response</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Arrest, Induced - methods</topic><topic>Heart Rate</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Left ventricular function</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Pressure-volume relations</topic><topic>Time Factors</topic><topic>Troponin T - blood</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tulner, Sven A.F.</creatorcontrib><creatorcontrib>Klautz, Robert J.M.</creatorcontrib><creatorcontrib>Engbers, Frank H.M.</creatorcontrib><creatorcontrib>Bax, Jeroen J.</creatorcontrib><creatorcontrib>Baan, Jan</creatorcontrib><creatorcontrib>van der Wall, Ernst E.</creatorcontrib><creatorcontrib>Dion, Robert A.E.</creatorcontrib><creatorcontrib>Steendijk, Paul</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tulner, Sven A.F.</au><au>Klautz, Robert J.M.</au><au>Engbers, Frank H.M.</au><au>Bax, Jeroen J.</au><au>Baan, Jan</au><au>van der Wall, Ernst E.</au><au>Dion, Robert A.E.</au><au>Steendijk, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left ventricular function and chronotropic responses after normothermic cardiopulmonary bypass with intermittent antegrade warm blood cardioplegia in patients undergoing coronary artery bypass grafting</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><stitle>Eur J Cardiothorac Surg</stitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2005-04-01</date><risdate>2005</risdate><volume>27</volume><issue>4</issue><spage>599</spage><epage>605</epage><pages>599-605</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract>Objective: Recent studies indicate that normothermic cardiopulmonary bypass (CPB) with intermittent antegrade warm blood cardioplegia (IAWBC) may have metabolic and clinical advantages, but limited data exist on its effects on myocardial function. Therefore, we investigated the acute effects of this approach on systolic and diastolic left ventricular function and on chronotropic responses. Methods: In 10 patients undergoing isolated CABG we obtained on-line left ventricular pressure-volume loops using the conductance catheter before and after normothermic CPB with IAWBC. Steady state and load-independent indices of left ventricular function derived from pressure-volume relations were obtained during right atrial pacing (80–100–120beats/min) to determine baseline systolic and diastolic function and chronotropic responses. Results: The mean time of CPB was 105±36min (median 103, range 60–167min) with a mean aortic cross-clamp time of 75±27min (median 69, range 43–129min). Baseline (80beats/min) end-systolic elastance (EES) did not change after CPB (1.22±0.53 to 1.12±0.28mmHg/ml, P≫0.2), while the diastolic chamber stiffness constant (kED) significantly increased (0.014±0.005 to 0.040±0.007ml−1, P=0.018) and relaxation time constant (τ) significantly decreased (61±3 to 49±2ms, P=0.004). Before CPB, incremental atrial pacing had no significant effects on EES and τ but significant negative effects on kED (0.014±0.005 to 0.045±0.012ml−1, P=0.013). After CPB, atrial pacing had significant positive effects on EES, τ and kED (EES: 1.12±0.28 to 2.60±1.54mmHg/ml, P=0.021; τ: 49±2 to 45±2ms, P=0.009; kED: 0.040±0.007 to 0.026±0.005mmHg, P=0.010), indicating improved systolic and diastolic chronotropic responses. Conclusion: On-pump normothermic CABG with IAWBC preserved systolic function, increased diastolic stiffness, and improved systolic and diastolic chronotropic responses. Normalization of the chronotropic responses post-CPB is likely due to effects of successful revascularization and subsequent relief of ischemia.</abstract><cop>Amsterdam</cop><pub>Elsevier Science B.V</pub><pmid>15784357</pmid><doi>10.1016/j.ejcts.2004.11.024</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1010-7940
ispartof European journal of cardio-thoracic surgery, 2005-04, Vol.27 (4), p.599-605
issn 1010-7940
1873-734X
language eng
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source Oxford Journals Online
subjects Aged
Biological and medical sciences
Biomarkers - blood
CABG
Cardiology. Vascular system
Cardioplegia
Cardiopulmonary Bypass - methods
Chronotropic response
Coronary Artery Bypass - methods
Coronary heart disease
Female
Heart
Heart Arrest, Induced - methods
Heart Rate
Hemodynamics
Humans
Left ventricular function
Male
Medical sciences
Middle Aged
Postoperative Period
Pressure-volume relations
Time Factors
Troponin T - blood
Ventricular Function, Left
title Left ventricular function and chronotropic responses after normothermic cardiopulmonary bypass with intermittent antegrade warm blood cardioplegia in patients undergoing coronary artery bypass grafting
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