DOPPLER-DERIVED LEFT-VENTRICULAR RATE OF PRESSURE RISE AND INOTROPIC REQUIREMENTS DURING MITRAL-VALVE SURGERY

Background: The estimation of left ventricular (LV) contractility is d ifficult in the presence of significant mitral regurgitation (MR). Pre diction of LV performance after MR repair is even more problematic. Th e intraoperative Doppler-derived LV rate of pressure rise (LV Delta P/ Delta t) analyzed before cardiopulmonary bypass (CPB) was presumed to be a useful predictive parameter for LV performance. Therefore, its re lation to perioperative inotropic requirements (PIR) necessary for sep aration from CPB after surgical MR repair was investigated. Methods: T wenty-eight patients scheduled for surgical MR repair fulfilled the se lection criteria. Pre-CPB LV Delta P/Delta t, pre-CPB echocardiographi c LV fractional area change (LV FAG), and pre-CPB thermodilution-deriv ed cardiac index (CI) were recorded. After MR repair, separation from CPB was performed with regard to standardized guidelines. PIR during t he first 60 minutes following separation were recorded. Results:Pre-CP B LV Delta P/Delta t could be assessed in 22 patients. Pre-CPB LV Delt a P/Delta t was 882 +/- 450 mmHg/sec, pre-CPB LV FAC was 49% +/- 9%, a nd pre-CPB CI was 2.0 +/- 0.2 L/kg/min. Pre-CPB LV Delta P/Delta t was significantly correlated with pre-CPB LV FAC (r=0.56), and with pre-C PB CI (r = 0.72). Inotropic support was necessary in 16 patients (73%) , and was best predicted by the pre-CPB LV Delta P/Delta t, by means o f logistic regression (p = 0.026).Conclusions: Doppler-derived LV Delt a P/Delta t was assessable in most patients with severe chronic MR, an d was the best intraoperative predictive parameter of post-CPB inotrop ic requirements after surgical MR repair. Copyright (C) 1998 by W.B. S aunders Company.