Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery

Department of Cardiology, University of Pittsburgh, School of Medicine, Pennsylvania.

To evaluate whether acute myocardial dysfunction was common in the early postoperative period, serial hemodynamic measurements and radionuclide evaluation of ventricular function were performed before and after operation in 24 patients undergoing elective coronary bypass surgery. All patients had uncomplicated surgery, and no patient sustained an intraoperative infarction. In 96% of patients, significant depression in right and left ventricular ejection fraction was seen postoperatively, reaching a nadir at 262 +/- 116 min after coronary bypass. Left ventricular ejection fraction was 58 +/- 12% preoperatively and 37 +/- 10% at trough. Right ventricular function displayed a similar pattern. These findings were also associated with depressed cardiac and left ventricular stroke work index despite maintenance of adequate ventricular filling pressures and mean arterial pressure. The depression in ventricular function was partially reversible within 8 to 10 h after surgery. Left ventricular ejection fraction had increased to 55 +/- 13% at 426 +/- 77 min after coronary bypass and showed complete recovery within 48 h. Left ventricular end-systolic and end-diastolic volume index increased significantly postoperatively, but recovery in left ventricular ejection fraction was mostly due to decreases in end-systolic volume index (50 +/- 22 ml at trough and 32 +/- 16 ml at recovery). Depressed myocardial function was independent of bypass time, number of grafts placed, preoperative medications or core temperatures postoperatively. Postoperative therapy with pressors or inotropic agents delayed but did not prevent the occurrence of postoperative ventricular dysfunction. Despite improvements in operative techniques and methods of myocardial protection, postoperative left ventricular dysfunction continues to be common in patients undergoing cardiopulmonary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				M.-G. Ryou, D. C. Flaherty, B. Hoxha, J. Sun, H. Gurji, S. Rodriguez, G. Bell, A. H. Olivencia-Yurvati, and R. T. Mallet Pyruvate-fortified cardioplegia evokes myocardial erythropoietin signaling in swine undergoing cardiopulmonary bypass Am J Physiol Heart Circ Physiol, November 1, 2009; 297(5): H1914 - H1922. [Abstract] [Full Text] [PDF]

				V. K. Lai, K.-L. Ang, W. Rathbone, N. J. Harvey, and M. Galinanes Randomized controlled trial on the cardioprotective effect of bone marrow cells in patients undergoing coronary bypass graft surgery Eur. Heart J., October 1, 2009; 30(19): 2354 - 2359. [Abstract] [Full Text] [PDF]

				K. W Kenyon Clevidipine: An Ultra Short-Acting Calcium Channel Antagonist for Acute Hypertension Ann. Pharmacother., July 1, 2009; 43(7): 1258 - 1265. [Abstract] [Full Text] [PDF]

				M. L. Fontes, S. Aronson, J. P. Mathew, Y. Miao, B. Drenger, P. G. Barash, D. T. Mangano, For the Multicenter Study of Perioperative Ischemi, and the Ischemia Research and Education Foundation (IR Pulse Pressure and Risk of Adverse Outcome in Coronary Bypass Surgery Anesth. Analg., October 1, 2008; 107(4): 1122 - 1129. [Abstract] [Full Text] [PDF]

				J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]

				S. Mizutani, A. Matsuura, K. Miyahara, T. Eda, A. Kawamura, T. Yoshioka, and K. Yoshida On-Pump Beating-Heart Coronary Artery Bypass: A Propensity Matched Analysis Ann. Thorac. Surg., April 1, 2007; 83(4): 1368 - 1373. [Abstract] [Full Text] [PDF]

				D. J. Chambers Oxidative stress injury during cardiac surgery: How important is it? Cardiovasc Res, March 1, 2007; 73(4): 626 - 628. [Full Text] [PDF]

				S Fratz, M Hauser, F M Bengel, A Hager, H Kaemmerer, M Schwaiger, J Hess, and H C Stern Myocardial scars determined by delayed-enhancement magnetic resonance imaging and positron emission tomography are not common in right ventricles with systemic function in long-term follow up Heart, November 1, 2006; 92(11): 1673 - 1677. [Abstract] [Full Text] [PDF]

				J. Poling, W. Rees, V. Mantovani, S. Klaus, L. Bahlmann, V. Ziaukas, N. Hubner, and H. Warnecke Evaluation of myocardial metabolism with microdialysis during bypass surgery with cold blood- or Calafiore cardioplegia. Eur. J. Cardiothorac. Surg., October 1, 2006; 30(4): 597 - 603. [Abstract] [Full Text] [PDF]

				L. Tritapepe, V. De Santis, D. Vitale, M. Santulli, A. Morelli, I. Nofroni, P. E. Puddu, M. Singer, and P. Pietropaoli Preconditioning effects of levosimendan in coronary artery bypass grafting--a pilot study Br. J. Anaesth., June 1, 2006; 96(6): 694 - 700. [Abstract] [Full Text] [PDF]

				S P Schoen, T Kittner, S Bohl, M U Braun, G Simonis, A Schmeisser, and R H Strasser Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study Heart, June 1, 2006; 92(6): 821 - 826. [Abstract] [Full Text] [PDF]

				I. Kirkeby-Garstad, U. Wisloff, E. Skogvoll, T. Stolen, A.-E. Tjonna, R. Stenseth, and O. F. Sellevold The marked reduction in mixed venous oxygen saturation during early mobilization after cardiac surgery: the effect of posture or exercise? Anesth. Analg., June 1, 2006; 102(6): 1609 - 1616. [Abstract] [Full Text] [PDF]

				R. T. Mallet, J. Sun, E. M. Knott, A. B. Sharma, and A. H. Olivencia-Yurvati Metabolic Cardioprotection by Pyruvate: Recent Progress Experimental Biology and Medicine, July 1, 2005; 230(7): 435 - 443. [Abstract] [Full Text] [PDF]

				M. M. Lalu, E. Pasini, C. J. Schulze, M. Ferrari-Vivaldi, G. Ferrari-Vivaldi, T. Bachetti, and R. Schulz Ischaemia-reperfusion injury activates matrix metalloproteinases in the human heart Eur. Heart J., January 1, 2005; 26(1): 27 - 35. [Abstract] [Full Text] [PDF]

				A. Kramer, D. Zygun, H. Hawes, P. Easton, and A. Ferland Pulse Pressure Variation Predicts Fluid Responsiveness Following Coronary Artery Bypass Surgery Chest, November 1, 2004; 126(5): 1563 - 1568. [Abstract] [Full Text] [PDF]

				J. Li, A. Hoschtitzky, M. L. Allen, M. J. Elliott, and A. N. Redington An Analysis of Oxygen Consumption and Oxygen Delivery in Euthermic Infants After Cardiopulmonary Bypass With Modified Ultrafiltration Ann. Thorac. Surg., October 1, 2004; 78(4): 1389 - 1396. [Abstract] [Full Text] [PDF]

				A. Khoynezhad, Z. Jalali, and A. J. Tortolani Apoptosis: Pathophysiology and therapeutic implications for the cardiac surgeon Ann. Thorac. Surg., September 1, 2004; 78(3): 1109 - 1118. [Abstract] [Full Text] [PDF]

				J. M. Leung, W. H. Bellows, and D. Pastor Does Intraoperative Evaluation of Left Ventricular Contractile Reserve Predict Myocardial Viability? A Clinical Study Using Dobutamine Stress Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery Anesth. Analg., September 1, 2004; 99(3): 647 - 654. [Abstract] [Full Text] [PDF]

				I. Kirkeby-Garstad, O. F. M. Sellevold, R. Stenseth, E. Skogvoll, and A. Karevold Marked Mixed Venous Desaturation During Early Mobilization After Aortic Valve Surgery Anesth. Analg., February 1, 2004; 98(2): 311 - 317. [Abstract] [Full Text] [PDF]

				J. B. Selvanayagam, S. E. Petersen, J. M. Francis, M. D. Robson, A. Kardos, S. Neubauer, and D. P. Taggart Effects of Off-Pump Versus On-Pump Coronary Surgery on Reversible and Irreversible Myocardial Injury: A Randomized Trial Using Cardiovascular Magnetic Resonance Imaging and Biochemical Markers Circulation, January 27, 2004; 109(3): 345 - 350. [Abstract] [Full Text] [PDF]

				S. Ghosh and M. Galinanes Protection of the human heart with ischemic preconditioning during cardiac surgery: role of cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 133 - 142. [Abstract] [Full Text] [PDF]

				E. o. Cosar and C. J. O'Connor Hibernation, Stunning, and Preconditioning: Historical Perspective, Current Concepts, Clinical Applications, and Future Implications Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2003; 7(2): 115 - 140. [Abstract] [PDF]

				M. B. Vroom Epidemiology and Pharmacotherapy of Acute Heart Failure Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 3 - 12. [PDF]

				I. Mayers, T. Hurst, A. Radomski, D. Johnson, S. Fricker, G. Bridger, B. Cameron, M. Darkes, and M. W. Radomski Increased matrix metalloproteinase activity after canine cardiopulmonary bypass is suppressed by a nitric oxide scavenger J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 661 - 668. [Abstract] [Full Text] [PDF]

				J. M. Bailey, K. A. Tanaka, and J. H. Levy Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2003; 2(2003): 85 - 118. [Full Text]

				H.-I Yeh, S.-H. Hou, H.-R. Hu, Y.-N. Lee, J.-Y. Li, E. Dupont, S. R. Coppen, Y.-S. Ko, N. J. Severs, and C.-H. Tsai Alteration of gap junctions and connexins in the right atrial appendage during cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1106 - 1112. [Abstract] [Full Text]

				D. T. Mangano and the Multicenter Study of Perioperative Ischemia Re Aspirin and Mortality from Coronary Bypass Surgery N. Engl. J. Med., October 24, 2002; 347(17): 1309 - 1317. [Abstract] [Full Text] [PDF]

				R. Ascione, S. Al-Ruzzeh, K. Amer, and G. D Angelini Subsystem organ function during coronary surgery Perfusion, July 1, 2002; 17(4): 295 - 303. [Abstract] [PDF]

				R Dhillon, M Josen, M Henein, and A Redington Transcatheter closure of atrial septal defect preserves right ventricular function Heart, May 1, 2002; 87(5): 461 - 465. [Abstract] [Full Text] [PDF]

				H. Mahrholdt, A. Wagner, R.M. Judd, and U. Sechtem Assessment of myocardial viability by cardiovascular magnetic resonance imaging Eur. Heart J., April 2, 2002; 23(8): 602 - 619. [Full Text] [PDF]

				J. P. Schmitt, J. Schroder, H. Schunkert, D. E. Birnbaum, and H. Aebert Role of apoptosis in myocardial stunning after open heart surgery Ann. Thorac. Surg., April 1, 2002; 73(4): 1229 - 1235. [Abstract] [Full Text] [PDF]

				M. Kikura and S. Sato The Efficacy of Preemptive Milrinone or Amrinone Therapy in Patients Undergoing Coronary Artery Bypass Grafting Anesth. Analg., January 1, 2002; 94(1): 22 - 30. [Abstract] [Full Text] [PDF]

				R. A. Kloner and R. B. Jennings Consequences of Brief Ischemia: Stunning, Preconditioning, and Their Clinical Implications: Part 1 Circulation, December 11, 2001; 104(24): 2981 - 2989. [Abstract] [Full Text] [PDF]

				I. Mayers, T. Hurst, L. Puttagunta, A. Radomski, T. Mycyk, G. Sawicki, D. Johnson, and M. W. Radomski Cardiac surgery increases the activity of matrix metalloproteinases and nitric oxide synthase in human hearts J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 746 - 752. [Abstract] [Full Text] [PDF]

				Y. Nakae, S. Fujita, and A. Namiki Isoproterenol Enhances Myofilament Ca2+ Sensitivity During Hypothermia in Isolated Guinea Pig Beating Hearts Anesth. Analg., October 1, 2001; 93(4): 846 - 852. [Abstract] [Full Text] [PDF]

				G. M. Janelle, F. Urdaneta, M. L. Blas, J. Shryock, Y.-S. Tang, T. D. Martin, and E. B. Lobato Inhibition of Phosphodiesterase Type III Before Aortic Cross-Clamping Preserves Intramyocardial Cyclic Adenosine Monophosphate During Cardiopulmonary Bypass Anesth. Analg., June 1, 2001; 92(6): 1377 - 1383. [Abstract] [Full Text] [PDF]

				H. Aebert, S. Kirchner, A. Keyser, D. E. Birnbaum, E. Holler, R. Andreesen, and G. Eissner Endothelial apoptosis is induced by serum of patients after cardiopulmonary bypass Eur. J. Cardiothorac. Surg., November 1, 2000; 18(5): 589 - 593. [Abstract] [Full Text] [PDF]

				C. M. Cox, R. Ascione, A. M. Cohen, I. M. Davies, I. G. Ryder, and G. D. Angelini Effect of cardiopulmonary bypass on pulmonary gas exchange: a prospective randomized study Ann. Thorac. Surg., January 1, 2000; 69(1): 140 - 145. [Abstract] [Full Text] [PDF]

				R R Chaturvedi, V E Hjortdal, E V Stenbog, H B Ravn, P White, T D Christensen, A B Thomsen, J Pedersen, K E Sorensen, and A N Redington Inhibition of nitric oxide synthesis improves left ventricular contractility in neonatal pigs late after cardiopulmonary bypass Heart, December 1, 1999; 82(6): 740 - 744. [Abstract] [Full Text]

				F. G. Spinale Cellular and molecular therapeutic targets for treatment of contractile dysfunction after cardioplegic arrest Ann. Thorac. Surg., November 1, 1999; 68(5): 1934 - 1941. [Abstract] [Full Text] [PDF]

				I. Mayers, E. Salas, T. Hurst, D. Johnson, and M. W. Radomski INCREASED NITRIC OXIDE SYNTHASE ACTIVITY AFTER CANINE CARDIOPULMONARY BYPASS IS SUPPRESSED BY S-NITROSOGLUTATHIONE J. Thorac. Cardiovasc. Surg., May 1, 1999; 117(5): 1009 - 1016. [Abstract] [Full Text] [PDF]

				A. Budrikis, R. Bolys, Q. Liao, R. Ingemansson, T. Sjoberg, and S. Steen Function of adult pig hearts after 2 and 12 hours of cold cardioplegic preservation Ann. Thorac. Surg., July 1, 1998; 66(1): 73 - 78. [Abstract] [Full Text] [PDF]

				R. A. Kloner, R. Bolli, E. Marban, L. Reinlib, and E. Braunwald Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning : An NHLBI Workshop Circulation, May 19, 1998; 97(18): 1848 - 1867. [Full Text] [PDF]

				C. G. Koch The Use of Echocardiography in the Intensive Care Unit Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1998; 2(1): 52 - 65. [Abstract] [PDF]

				R. R. Chaturvedi, C. Lincoln, J. W. W. Gothard, M. H. Scallan, P. A. White, A. N. Redington, and D. F. Shore Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: Quantitation with the use of a conductance catheter immediately after bypass J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 77 - 83. [Abstract] [Full Text] [PDF]

				M. P. Reilly, N. Delanty, L. Roy, J. Rokach, P. O. Callaghan, P. Crean, J. A. Lawson, and G. A. FitzGerald Increased Formation of the Isoprostanes IPF2{alpha}-I and 8-Epi-Prostaglandin F2{alpha} in Acute Coronary Angioplasty : Evidence for Oxidant Stress During Coronary Reperfusion in Humans Circulation, November 18, 1997; 96(10): 3314 - 3320. [Abstract] [Full Text]

				C. Patrono and G. A. FitzGerald Isoprostanes: Potential Markers of Oxidant Stress in Atherothrombotic Disease Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 2309 - 2315. [Abstract] [Full Text]

				J.-Y. Dupuis, K. Li, A. Calderone, H. Gosselin, X.-P. Yang, M. B Anand-Srivastava, J. Teijeira, and J.-L. Rouleau {beta}-Adrenergic signal transduction and contractility in the canine heart after cardiopulmonary bypass Cardiovasc Res, November 1, 1997; 36(2): 223 - 235. [Abstract] [Full Text] [PDF]

				N. Delanty, M.P. Reilly, D. Pratico, J.A. Lawson, J.F. McCarthy, A.E. Wood, S.T. Ohnishi, D.J. Fitzgerald, and G.A. FitzGerald 8-Epi PGF2{alpha} Generation During Coronary Reperfusion: A Potential Quantitative Marker of Oxidant Stress In Vivo Circulation, June 3, 1997; 95(11): 2492 - 2499. [Abstract] [Full Text]

				G. E. Cimochowski, M. D. Harostock, and P. J. Foldes MINIMAL OPERATIVE MORTALITY IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS WITH SIGNIFICANT LEFT VENTRICULAR DYSFUNCTION BY MAXIMIZATION OF METABOLIC AND MECHANICAL SUPPORT J. Thorac. Cardiovasc. Surg., April 1, 1997; 113(4): 655 - 666. [Abstract] [Full Text]

				E. Bennett-Guerrero, J. L. Jimenez, W. D. White, E. B. D'Amico, B. I. Baldwin, D. A. Schwinn, Duke T3 Study Group, N. P. Bouknight, C. M. Chuey, F. M. Clements, et al. Cardiovascular Effects of Intravenous Triiodothyronine in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized, Double-blind, Placebo-Controlled Trial JAMA, March 6, 1996; 275(9): 687 - 692. [Abstract] [PDF]

				D. J. Chambers, K. Haire, N. Morley, L. Fairbanks, E. Strumia, C. P. Young, and G. E. Venn St. Thomas' Hospital Cardioplegia: Enhanced Protection With Exogenous Creatine Phosphate Ann. Thorac. Surg., January 1, 1996; 61(1): 67 - 75. [Abstract] [Full Text]

				V. G. Davila-Roman, A. D. Waggoner, W. E. Hopkins, and B. Barzilai Right Ventricular Dysfunction in Low Output Syndrome After Cardiac Operations: Assessment by Transesophageal Echocardiography Ann. Thorac. Surg., October 1, 1995; 60(4): 1081 - 1086. [Abstract] [Full Text]

				M. T. McEnany Sternal Traction After Open Heart Operation: An Effective Alternative to Delayed Sternal Closure Ann. Thorac. Surg., August 1, 1995; 60(2): 387 - 391. [Abstract] [Full Text]

				F.W. Mohr, V. Falk, R. Autschbach, A. Diegeler, B. Schorn, A. Weyland, M. Vettelschoß, B. Frank, J. Gummert, and H. Dalichau One-Stage Surgery of Coronary Arteries and Abdominal Aorta in Patients With Impaired Left Ventricular Function Circulation, January 15, 1995; 91(2): 379 - 385. [Abstract] [Full Text]