Licker M, Diaper J, Sologashvili T, Ellenberger C.
BMC Anesthesiology volume 19, Article number: 175 (2019)
Currently, aortic valve replacement (AVR) remains the standard of care to treat patients with severe aortic valvular stenosis, although elderly and high-risk patients may now benefit from a lesser invasive transarterial vascular approach . Low cardiac output syndrome occurs in 5 to 15% of patients undergoing open heart surgery and is a main cause of mortality . Following AVR, patients with aortic stenosis are prone to develop myocardial injuries and contractile dysfunction owing to difficulties in protecting the hypertrophic heart with cardioplegic solutions [2, 3].
The term “postcardiotomy ventricular dysfunction” (PCVD) has been coined to define new onset or worsening heart failure that develops following weaning from cardiopulmonary bypass (CPB) and that requires support with inotropes . Transesophageal echocardiography (TEE) coupled with haemodynamic monitoring allows the cardiac team to distinguish PCVD from other functional or structural abnormalities such as valve prosthesis/patient mismatch, myocardial ischemia or systolic anterior motion of the anterior mitral leaflet [5, 6].
In animal models of ischemia-reperfusion, there is strong evidence that the infusion of glucose-insulin-potassium (GIK) minimizes myocardial injuries [7, 8]. In patients undergoing open heart surgery, although the administration of GIK has been shown to improve cardiac output, few and conflicting results have been reported regarding functional ventricular performances [9, 10].
The aim of this study was to investigate the changes in left ventricular function using TEE, in moderate-to-high risk patients undergoing AVR.