• Stefan Bloechlinger, David Berger, Jürg Bryner, Eva Roost, Stephan Jakob, Martin W Dünser, and Jukka Takala.
• Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland. Electronic address: stefan.bloechlinger@insel.ch.
• J. Cardiothorac. Vasc. Anesth. 2015 Aug 1; 29 (4): 860-7.

ObjectiveIn 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.DesignProspective, clinical single-center study.SettingIntensive care unit of a university hospital.Participants12 patients undergoing elective aortic valve replacement for aortic stenosis.InterventionsEchocardiography was performed on the day before surgery, within 18 hours after surgery including a fluid challenge, and after 2.5 years.Measurements And Main ResultspT 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).ConclusionspT decreased early after aortic valve replacement but remained elevated despite elimination of aortic stenosis. After 2.5 years, torsion had returned to preoperative levels.Copyright © 2015 Elsevier Inc. All rights reserved.

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