Perioperative care in left ventricular volume reduction.
BACKGROUND
While the operative technique of left ventricular volume reduction (LVVR) is rapidly becoming standardized, the optimal perioperative management strategy is yet to be determined. We present our experience with the care of patients undergoing LVVR.


METHODS
LVVR was performed in 21 patients (mean age = 65.5 years) with congestive heart failure. Our management strategy was initially based on afterload reduction with sodium nitroprusside, but was later modified to include routine preoperative intra-aortic balloon support, normothermic cardiopulmonary bypass, antegrade intermittent warm blood cardioplegia, and postoperative support with phosphodiesterase-III inhibitors. Hemodynamic manipulations are aimed to attain systemic vascular resistance between 600 and 800 dyne/sec per cm(-5) and the lowest mean blood pressure that is able to maintain satisfactory systemic perfusion. Postoperatively, aggressive antifailure medical therapy with a high dose of angiotensin converting enzyme inhibitors, nitrates, and diuretics was initiated early and maintained indefinitely.


RESULTS
Using this approach, postoperative progress was characterized by hemodynamic stability. IABP support was used for 59.6+/-9 hours following surgery, and inotropic support for 103+/-12 hours. In our series there were four (19%) in-hospital deaths, two of which were related to heart failure.


CONCLUSIONS
The described approach is associated with an acceptable early outcome. However, further advances in myocardial protection methods and pharmacological and mechanical support techniques are necessary for a wider adoption of this procedure.
Izzat
M B
MB
Division of Cardiothoracic Surgery, The Chinese University of Hong Kong. bizzat@net.sy
Buckley
T
T
Khaw
K S
KS
Yim
A P
AP
Sanderson
J E
JE
Angelini
G D
GD
D000368:Aged; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D010726:Phosphodiesterase Inhibitors