scholarly journals Clinical Impact of Custodiol Cardioplegic Solution on Patients Undergoing Complex Cardiac Surgery With Mild to Moderate Impairment of Left Ventricular Systolic Function

2017 ◽  
Vol 13 (30) ◽  
pp. 285
Author(s):  
Mona Ramadan ◽  
Ahmed Abdelgawad
Keyword(s):  
Cardiac Surgery ◽  
Single Dose ◽  
Myocardial Protection ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Cardioplegic Solution ◽  
Ventricular Systolic Function ◽  
Htk Solution

Background: The Bretschneider HTK solution is used widely for multiorgan preservation for transplantation, as well as a cardioplegic agent that allows single dose administration which is an attractive option for lengthy complex cardiac surgery. It was proved that it is simple to use, safe and practical. Moreover, it is considered to confer sufficient myocardial protection for more than 2 h of cardiac arrest. We undertook this descriptive study to analyze the performance of HTK solution in patients undergoing complex cardiac surgery with mild to moderate impairment of left ventricular systolic function. Patients and methods: A total of 50 patients underwent different complex cardiac surgery at national heart institute from January 2015 to November 2016 using single dose Custodiol cardioplegia as the primary and sole cardioplegic agent, their data was prospectively collected and their hospital outcome was analyzed as regards to ten study endpoints namely Prolonged ventilation, return to theatre for bleeding, renal failure, stroke, 30 days mortality, postoperative MI, need for inotropes, time on inotropes, ICU stay and hospital stay. Pre- and postoperative echocardiography was done to compare and evaluate the change of LV function using the parameters of End Systolic Dimension, End Diastolic Dimension, Fraction Shortening and Ejection Fraction of the left ventricle. Results: Half of the patients were males. Their age ranged between 16 – 65 years with a mean (standard deviation) of 47.46(11.10). preoperative ejection fraction ranged from 30 % to 49% with a mean (standard deviation) of 41.8 (6.32), the majority of them (64%) had NYHA class of 3 and half of them had CCS of 3. all patients were done electively. The most common procedure done was redo DVR 24% (12 patients) followed by Bentall operation 22%(11 patients). This is followed by CABG + MVR 7 patients (14%), then an equal number of 6 patients (12%) who underwent redo MVR post-infective endocarditis and CABG+ MVrep. The repair of tricuspid valve was done for 14 patients (28%) either with MVR or DVR. 4 patients (8%) had CABG +AVR for their combined lesions and another equal number of two patients (4%) underwent redo CABG and AVR + conduit (valve separate tube graft operation). prolonged ventilation occurred in 20% of the cases. An equal percentage of 6% of the patients had to return to the operative room and had postoperative MI. Renal failure occurred in 4% of the patients and as far as 30-day mortality is concerned, a similar 4% of patients died within this period. EF and FS were very similar when compared together (41.8 ± 6.32 %, 20.8 ± 2.35 % preoperatively compared to 41.92 ± 7.49%, 20.85 ± 3.25% postoperatively). P value was insignificant (0.937 and 0.929) respectively. Conclusion: A single dose of an HTK cardioplegic solution provides good myocardial protection in complex cardiac surgery with mild to moderate impairment of LV function and has a good immediate postoperative outcome.

Determinants of Discrepancy in the Left Ventricular Systolic Function Evaluation Between Preoperative and Intraoperative Evaluations

2020 ◽  
Vol 24 (4) ◽  
pp. 321-327
Author(s):  
Chad Spencer ◽  
Nasir Khatri ◽  
Alan M. Smeltz
Keyword(s):  
Cardiac Surgery ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Function Evaluation ◽  
Ventricular Systolic Function ◽  
Elective Cardiac Surgery ◽  
Global Systolic Function

Unexpectedly decreased left ventricular global systolic function can be difficult to manage, even for patients undergoing elective cardiac surgery, and should prompt a multidisciplinary discussion. Therefore, in this review, we discuss the evidence describing key perioperative variables expected to influence left ventricular systolic function to facilitate this discussion.

Left ventricular systolic function

2020 ◽  
pp. 83-92
Author(s):  
Nick Fletcher
Keyword(s):  
Critically Ill ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Daily Practice ◽  
Left Ventricular ◽  
Alternative Methods ◽  
Critically Ill Patient ◽  
Lv Function ◽  
Ventricular Systolic Function ◽  
Universal Language

Left ventricular systolic function assessment is an essential component of the echocardiographic assessment of the critically ill patient. A wide range of diseases from sepsis to coronary ischaemia can affect the left ventricle (LV). An understanding of the events and timings in LV systole within the cardiac cycle is important, together with an appreciation of LV anatomy and geometry. Advanced echocardiography requires the competence to obtain all the imaging planes relevant to the LV in transthoracic (TTE) and transoesophageal (TOE) echocardiography. Ejection fraction is currently regarded as the gold standard for LV function and biplane Simpson’s method is the most accurate way to measure this at the critical care bedside, although newer applications such as strain may become more widely used in future. Imaging can be technically difficult in critically ill patients and a detailed knowledge of sources of technical error and physiological confounders is crucial. For the same reason, a knowledge of the alternative methods of LV systolic assessment to employ is also important. Many intrinsic diseases of the heart will be encountered in daily practice and require communication and referral to cardiologists. It is important in this setting that both clinicians are able to converse in the universal language of echocardiography. A comprehensive knowledge of regional wall anatomy and function will enable prompt diagnosis and management of coronary syndromes, particularly as onset of dysfunction can be rapid and serious in critical illness. Finally, an understanding of LV function and assessment in the context of sepsis syndromes is a key concept.

scholarly journals Acute biventricular pacing after cardiac surgery has no influence on regional and global left ventricular systolic function

EP Europace ◽  
2007 ◽  
Vol 9 (6) ◽  
pp. 432-436 ◽  
Author(s):  
Christoph Schmidt ◽  
Jürgen Frielingsdorf ◽  
Marianne Debrunner ◽  
Reza Tavakoli ◽  
Michele Genoni ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Systolic Function ◽  
Biventricular Pacing ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Global Left Ventricular

scholarly journals Assessing the Left Ventricular Systolic Function at the Bedside: The Role of Transpulmonary Thermodilution-Derived Indices

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Gerardo Aguilar ◽  
F. Javier Belda ◽  
Carlos Ferrando ◽  
José Luis Jover
Keyword(s):  
Transpulmonary Thermodilution ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Monitoring Tool ◽  
Ventricular Systolic Function ◽  
Hemodynamic Management ◽  
Long Time

Evaluating the systolic function of the left ventricle (LV) is important in the hemodynamic management of the critically ill patients with circulatory failure. Echocardiography is considered the standard monitor for estimating the LV function at the bedside in the intensive care unit. However, it requires a trained operator and is not a real-time monitoring tool. For monitoring of the systolic function, the pulmonary artery catheter has been the gold standard for a long time. However, now there are alternatives to this device, with transpulmonary thermodilution being one of them. This paper provides an overview of the usefulness of the transpulmonary thermodilution-derived indices for assessing systolic function at the bedside.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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