Changes in Left Ventricular Torsion Early Postoperatively After Aortic Valve Replacement and at Long-Term Follow-up.

Bloechlinger, Stefan; Berger, David; Bryner, Jürg; Roost, Eva; Jakob, Stephan; Dünser, Martin W; Takala, Jukka (2015). Changes in Left Ventricular Torsion Early Postoperatively After Aortic Valve Replacement and at Long-Term Follow-up. Journal of cardiothoracic and vascular anesthesia, 29(4), pp. 860-867. Elsevier 10.1053/j.jvca.2015.01.010

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OBJECTIVE

In patients with aortic stenosis, left ventricular systolic torsion (pT) is increased to overcome excessive afterload. This study assessed left ventricular torsion before and immediately after surgical valve replacement and tested the instant effect of fluid loading.

DESIGN

Prospective, clinical single-center study.

SETTING

Intensive care unit of a university hospital.

PARTICIPANTS

12 patients undergoing elective aortic valve replacement for aortic stenosis.

INTERVENTIONS

Echocardiography was performed on the day before surgery, within 18 hours after surgery including a fluid challenge, and after 2.5 years.

MEASUREMENTS AND MAIN RESULTS

pT decreased early postoperatively by 21.2% (23.4° ± 5.6° to 18.4° ± 6.9°; p = 0.012) and reached preoperative values at 2.5 years follow-up (24 ± 7). Peak diastolic untwisting velocity occurred later early postoperatively (13% ± 8% to 21% ± 9.4%; p = 0.019) and returned toward preoperative values at follow-up (10.2 ± 4.7°). The fluid challenge increased central venous pressure (8 ± 4 mmHg to 11 ± 4 mmHg; p = 0.003) and reduced peak systolic torsion velocity (138.7 ± 37.6/s to 121.3 ± 32/s; p = 0.032). pT decreased in 3 and increased in 8 patients after fluid loading. Patients whose pT increased had higher early mitral inflow velocity postoperatively (p = 0.04) than those with decreasing pT. Patients with reduced pT after fluid loading received more fluids (p = 0.04) and had a higher positive fluid balance during the intensive care unit stay (p = 0.03). Torsion after fluid loading correlated with total fluid input (p = 0.001) and cumulative fluid balance (p = 0.002).

CONCLUSIONS

pT decreased early after aortic valve replacement but remained elevated despite elimination of aortic stenosis. After 2.5 years, torsion had returned to preoperative levels.

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