• R C W Gielgens, Herold I H F IHF Department of Anesthesiology and Intensive-Care, Catharina Hospital, Eindhoven, The Netherlands., van Straten A H M AHM Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands., B M van Gelder, F A Bracke, Korsten H H M HHM Department of Anesthesiology and Intensive-Care, Catharina Hospital, Eindhoven, The Netherlands., M A Soliman Hamad, and R A Bouwman.
• Department of Anesthesiology and Intensive-Care, Catharina Hospital, Eindhoven, The Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: gielgens.rcw@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2018 Feb 1; 32 (1): 259-266.

ObjectivesPatients with decreased left ventricular function undergoing cardiac surgery have a greater chance of difficult weaning from cardiopulmonary bypass and a poorer clinical outcome. Directly after weaning, interventricular dyssynchrony, paradoxical septal motion, and even temporary bundle-branch block might be observed. In this study, the authors measured arterial dP/dtmax, mean arterial pressure (MAP), and cardiac index using transpulmonary thermodilution, pulse contour analysis, and femoral artery catheter and compared the effects between right ventricular (A-RV) and biventricular (A-BiV) pacing on these parameters.DesignProspective study.SettingSingle-center study.ParticipantsThe study comprised 17 patients with a normal or prolonged QRS duration and a left ventricular ejection fraction ≤35% who underwent coronary artery bypass grafting with or without valve replacement.InterventionsTemporary pacing wires were placed on the right atrium and both ventricles. Different pacing modalities were used in a standardized order.Measurements And Main ResultsA-BiV pacing compared with A-RV pacing demonstrated higher arterial dP/dtmax values (846 ± 646 mmHg/s v 800 ± 587 mmHg/s, p = 0.023) and higher MAP values (77 ± 19 mmHg v 71 ± 18 mmHg, p = 0.036).ConclusionIn patients with preoperative decreased left ventricular function undergoing coronary artery bypass grafting, A-BiV pacing improve the arterial dP/dtmax and MAP in patients with both normal and prolonged QRS duration compared with standard A-RV pacing. In addition, arterial dP/dtmax and MAP can be used to evaluate the effect of intraoperative pacing. In contrast to previous studies using more invasive techniques, transpulmonary thermodilution is easy to apply in the perioperative clinical setting.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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