Hemodynamics at rest do not match clinical improvement after surgical ventricular restoration.
OBJECTIVE
The aim was to study the change in cardiac index (CI) and pulmonary artery pressure (PAP) by intra-cardiac measurements after surgical ventricular restoration (SVR) in patients with left ventricular aneurysm and symptoms of heart failure. Aspects of functional improvement were analyzed as secondary outcomes.


METHODS
Mean PAP and CI were obtained before and 6 months postoperatively in 22 patients who underwent SVR.


RESULTS
There were no significant changes in CI (2.3 vs. 2.4 L/min/m(2); p=0.91) or mean PAP (22 vs. 22 mmHg; p=0.64) at rest before and six months after surgery. Left ventricular ejection fraction improved from 25 to 38% (p<0.001). Before surgery 15 patients (68%) were in NYHA class III-IV and 6 months after the operation 19 (86%) patients were in NYHA class I-II (p<0.001).


CONCLUSIONS
Invasive hemodynamic measurements under resting conditions do not correspond well to the significant clinical improvement noted in these patients. Studies during exercise conditions are necessary to further evaluate this procedure.
Sartipy
Ulrik
U
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden. Ulrik.Sartipy@karolinska.se
Albåge
Anders
A
Insulander
Per
P
Lindblom
Dan
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz; D005080:Exercise Test; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology; D020127:Recovery of Function; D012042:Registries; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain