Diastolic dysfunction is predictive of difficult weaning from cardiopulmonary bypass

Diastolic function is receiving more attention since echocardiographic meas urements were developed and have become widely available. The importance an d significance of diastolic dysfunction (DD) observed before cardiac surger y and its relationship with adverse outcomes, such as difficult separation from cardiopulmonary bypass (CPB), have not been fully explored. In this st udy, we hypothesize that DD can be a predictor for the need of inotropic su pport to successfully separate from CPB. Ninety-two consecutive patients un derwent surgery during the study period. Twenty-six patients were excluded. From the remaining 66 patients, 52 had coronary artery bypass grafting alo ne and 14 combined procedures, valvular surgery, and reoperations (redo). S ystolic and diastolic function was evaluated by two experts blinded as to t he clinical data except for the age. The evaluation of diastolic function w as done according to published guidelines. The demographic, echocardiograph ic, and hemodynamic Variables were entered in a logistic regression analysi s to determine which variables were independent predictors of difficult sep aration from CPB and the need for postoperative vasoactive support. DD was present in 20 patients (30%). Patients with DD had lower weight (P = 0.046) ,less frequent coronary artery bypass grafting alone (P = 0.0004), more myo cardial infarction before surgery (P = 0.02), higher regional wall motion s core index (P = 0.0002), and larger left ventricle (P = 0.03). Total CPB ti me (P = 0.004) and ischemic time (P = 0.007) were longer in the DD group. P atients with DD required more frequent inotropic support at the end of surg ery (P = 0.006) and up to 12 h after surgery (P = 0.003). Multivariate logi stic regression identified female sex, DD, and total CPB time as predictive of difficult weaning and inotropic requirements up to 12h after surgery.