Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

Lan-Ting Zhao,Chun-Yan Ma,Tian-Xiang Gu,Yong-Huai Wang,Jun Yang,Ping-Ping Meng,Lu Liu,Meng Li

doi:10.1186/s12947-020-00206-1

Lan-Ting Zhao, Chun-Yan Ma + Show 6 more

Open Access

https://doi.org/10.1186/s12947-020-00206-1

Copy DOI

Abstract

BackgroundAccurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG.MethodsIntraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously.ResultsLV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged.ConclusionsPericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.

Highlights

Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG)
Deformation parameters obtained by two-dimensional speckle tracking echocardiography (2D Two-dimensional speckle tracking echocardiography (STE)) can sensitively detect subtle LV dysfunction at an early stage, LV global longitudinal strain (GLS), in particular, appears to be a more robust parameter and has incremental value in patients referred for cardiac surgery including CABG [1,2,3,4,5,6]
Hemodynamics measurements before versus after pericardial incision Immediately after pericardial incision, there was no significant change in central venous pressure (CVP), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) (Table 2)

Summary

Introduction

Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Echocardiography is an optimal, noninvasive method for precisely evaluating left ventricular (LV) systolic function, which has an important role in estimating the therapeutic effect in patients after CABG. We sought to investigate the effect of pericardial incision on LV morphology and systolic function during CABG using intraoperative transesophageal echocardiography (TEE)

Methods

Results

Conclusion