Transient hemodynamic dysfunction after myocardial revascularization: Temperature dependence

Abstract

We studied hemodynamics and the effects of right atrial pacing (110 beats/min) following complete myocardial revascularization and hypothermic multidose potassium crystalloid cardioplegia in 12 patients with a normal preoperative left ventricular ejection fraction (LVEF). Measurements were made immediately preoperatively, postoperatively at specified temperatures during the rewarming period (90 degrees F, 94 degrees F, and 98 degrees F), and at 24 hours. No patient had a perioperative myocardial infarction. At 90 degrees F, hemodynamics were characterized by significant decreases in cardiac index, stroke volume index, and left ventricular stroke work index (LVSW) and an increase in systemic vascular resistance index (SVRI) compared to preoperative values (p less than 0.05). Right atrial pacing significantly increased cardiac index preoperatively and 24 hours postoperatively, but not during the rewarming period. Over the entire rewarming period (90 degrees F to 98 degrees F), each of the following variables correlated with temperature: cardiac index (r = 0.71 in sinus rhythm and r = 0.66 with right atrial pacing); stroke volume index (r = 0.33 and 0.66); SVRI (r = -0.80 and -0.64); LVSW (r = 0.37 and 0.73); and heart rate in sinus rhythm (r = 0.51). During the rewarming period, there was an inverse relationship between cardiac index and SVRI (r = -0.87). In conclusion, after myocardial revascularization: (1) transient hemodynamic dysfunction occurs during the rewarming period (90 degrees F to 98 degrees F); (2) this dysfunction is temperature-dependent; and (3) right atrial pacing at 110 beats/min does not improve hemodynamic function during the rewarming period. Temperature must be considered in the evaluation of left ventricular and hemodynamic function following myocardial revascularization.