Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsOK and ELatz performed the data collection in the surgical patient group. EJG-B, MM, CR and CS performed the data collection and cytokine stimulation experiments in patients with VAP. AK and KZ performed data collection and cytokine measurements in cardiac surgery patients. DYO recruited control patients and performed data collection. LH and ELorenz perform
More than 200,000 aortic valve replacements are performed annually worldwide and this number will continue to increase with the aging population. Over the last two decades, the operative mortality rate has steadily declined from 10% to 4% along with improvements in surgical and anesthetic techniques [1-3]. However, left ventricular (LV) dysfunction requiring the administration of inotropic drugs often occurs after separation from cardiopulmonary bypass (CPB) and has been associated with prolonged ICU and hospital stay [3,4]. Although this myocardial stunning usually resolves within 48 hours, it may lead to low cardiac output syndrome that has become the leading cause of postoperative death [5,6].In large cohorts of patients undergoing cardiac surgery, post-CPB LV dysfunction has been linked to age, female gender, history of heart failure, recent myocardial infarct, low LV ejection fraction, prolonged aortic cross-clamping and complexity of surgery [7-11]. More recently, echocardiographic markers of preoperative LV diastolic dysfunction have been associated with difficulties in weaning patients from CPB [12,13].Although clinical signs (for example, pulmonary congestion, New York Heart Association [NYHA] classes) and markers of systolic LV function (for example, LV ejection fraction) have been studied extensively and incorporated in scoring algorithms for predicting perioperative risk, the prognostic value of diastolic dysfunction assessed by transoesophageal echocardiography (TEE) has not been examined in patients undergoing aortic valve replacement [1,2,5,14,15]. Besides pulsed-wave Doppler measurements of mitral inflow and pulmonary venous flow, evaluation of diastolic function has recently been improved with color M-mode transmitral flow propagation velocity (Vp) and mitral valve annular velocities recorded by tissue Doppler imaging (TDI) [16,17].The main purpose of this study was to identify predictors of LV dysfunction in high-risk patients with aortic stenosis undergoing valvular replacement. Secondarily, we analyzed different Doppler parameters of diastolic function regarding their ability to predict post-CPB LV dysfunction.