Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2296-2306. doi: 10.1053/j.jvca.2024.07.003. Epub 2024 Jul 6.
Evaluation of noninvasive left ventricular (LV) myocardial work (MW) enables insights into cardiac contractility and efficacy beyond conventional echocardiography. However, there is limited intraoperative data on patients undergoing surgical aortic valve replacement (AVR). The aim of this study was to describe the feasibility and the intraoperative course of this technique of ventricular function assessment in these patients and compare it to conventional two (2D)- and three-dimensional (3D) echocardiographic measurements and strain analysis.
Prospective observational study.
Single university hospital.
Twenty-five patients scheduled for isolated AVR with preoperative preserved left and right ventricular function, sinus rhythm, without significant other heart valve disease or pulmonary hypertension, and an uneventful intraoperative course.
Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Evaluation was performed in stable hemodynamics, in sinus rhythm or atrial pacing and vasopressor support with norepinephrine ≤ 0.1 µg/kg/min.
EchoPAC v206 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2D and 3D LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), and LV global work efficiency (GWE). Estimation of myocardial work was feasible in all patients. Although there was no significant difference in the values of 2D and 3D EF, GWI and GCW decreased significantly after AVR (T1 v T2, 1,647 ± 380 mmHg% v 1,021 ± 233 mmHg%, p < 0.001; T1 v T2, 2,095 ± 433 mmHg% v 1,402 ± 242 mmHg%, p < 0.001, respectively), while GWW remained unchanged (T1 v T2, 296 mmHg% [IQR 178-452) v 309 mmHg% [IQR 255-438), p = 0.97). This resulted in a decreased GWE directly after bypass (T1 v T2, 84% ± 6% v 78% ± 5%, p < 0.001), but GWE already improved at the end of surgery (T2 v T3, 78% ± 5% v 81% ± 5%, p = 0.003). There was no significant change in the values of GWI, GCW, or 2D and 3D LVEF before and after sternal closure (T2 v T3).
LV MW analysis showed a reduction of LV workload after bypass in our group of patients, which was not detected by conventional echocardiographic measures. This evolving technique provides deeper insights into cardiac energetics and efficiency in the perioperative course of aortic valve replacement surgery.
评估无创性左心室（LV）心肌做功（MW）可以深入了解心脏收缩力和功效，超越传统的超声心动图。然而，在接受主动脉瓣置换术（AVR）的患者中，术中数据有限。本研究的目的是描述在这些患者中评估心室功能的这种技术的可行性和术中过程，并将其与传统的二维（2D）和三维（3D）超声心动图测量和应变分析进行比较。
前瞻性观察性研究。
单所大学医院。
25 名计划接受孤立性 AVR 的患者，术前左、右心室功能正常，窦性节律，无明显其他心脏瓣膜疾病或肺动脉高压，术中无并发症。
在麻醉诱导后（T1）、体外循环结束后（T2）和胸骨闭合后（T3）进行经食管超声心动图检查。评估在稳定的血液动力学、窦性节律或房性起搏以及去甲肾上腺素≤0.1μg/kg/min 的情况下进行。
使用 EchoPAC v206 软件（GE Vingmed Ultrasound AS，挪威）分析 2D 和 3D LV 射血分数（EF）、LV 整体纵向应变（GLS）、LV 整体做功指数（GWI）、LV 整体构造成功率（GCW）、LV 整体浪费功（GWW）和 LV 整体工作效率（GWE）。在所有患者中，心肌做功的评估都是可行的。尽管 2D 和 3D EF 值没有显著差异，但 AVR 后 GWI 和 GCW 显著降低（T1 v T2，1647±380mmHg% v 1021±233mmHg%，p<0.001；T1 v T2，2095±433mmHg% v 1402±242mmHg%，p<0.001），而 GWW 保持不变（T1 v T2，296mmHg%[IQR 178-452] v 309mmHg%[IQR 255-438]，p=0.97）。这导致旁路后 GWE 直接降低（T1 v T2，84%±6% v 78%±5%，p<0.001），但手术结束时 GWE 已经改善（T2 v T3，78%±5% v 81%±5%，p=0.003）。胸骨闭合前后（T2 v T3），GWI、GCW 或 2D 和 3D LVEF 值没有显著变化。
在我们的患者组中，LV MW 分析显示旁路后 LV 工作量减少，这在传统超声心动图测量中未被检测到。这种不断发展的技术为主动脉瓣置换术围手术期的心脏能量学和效率提供了更深入的了解。
