Leiden University Scholarly Publications

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Brinke, E.A. ten (2011)

Hemodynamic folluw-up after heart failure surgery : systolic and diastolic function

Doctoral Thesis
This thesis evaluates, using various methods, two important surgical procedures currently used in heart failure patients: surgical ventricular restoration and restrictive mitral annuloplasty. The conductance catheter was used to analyze the hemodynamic effects of heart failure surgery invasively. It demonstrated improvement in systolic function of the left ventricle for both procedures at long term follow-up. Diastolic function demonstrated signs of impairment, although the functional effect remained limited, regarding limited or no increase in left ventricular end-diastolic pressure for SVR and RMA, respectively. Furthermore, assessment of left ventricular volumes demonstrated persistent reverse remodeling at follow-up. Clinical performance demonstrated significant improvement for both surgical procedures. The hemodynamic results together with the positive clinical outcome for both surgical procedures supports the use of these procedures in end-stage heart failure patients....Show moreThis thesis evaluates, using various methods, two important surgical procedures currently used in heart failure patients: surgical ventricular restoration and restrictive mitral annuloplasty. The conductance catheter was used to analyze the hemodynamic effects of heart failure surgery invasively. It demonstrated improvement in systolic function of the left ventricle for both procedures at long term follow-up. Diastolic function demonstrated signs of impairment, although the functional effect remained limited, regarding limited or no increase in left ventricular end-diastolic pressure for SVR and RMA, respectively. Furthermore, assessment of left ventricular volumes demonstrated persistent reverse remodeling at follow-up. Clinical performance demonstrated significant improvement for both surgical procedures. The hemodynamic results together with the positive clinical outcome for both surgical procedures supports the use of these procedures in end-stage heart failure patients. Regarding the fact that using the conductance catheter is time consuming and can be burdensome for patients, a demand for less invasive methods was generated. Evaluation of alternative methods demonstrated that heart failure surgery can also be evaluated by single-beat analysis, a simplified method of the conventional conductance catheter method avoiding load interventions by temporary vena cava occlusions. Furthermore, echocardiography and to a certain extent, serum biomarker analysis can also be used.Show less
Heart Failure
Systolic Function
Surgical Ventricular Restoration
Surgery
Restrictive Mitral Annuloplasty
Pressure-Volume Loops
Left Ventricle
Hemodynamics
Heart surgery failure
Echocardiography
Diastolic Function
Conductance Catheter
All authors
Brinke, E.A. ten
Supervisor
Klautz, R.J.M.; Wall, E.E. van der
Co-supervisor
Steendijk, P.
Qualification
Doctor (dr.)
Awarding Institution
Leiden University Medical Center (LUMC), Leiden University
Date
2011-09-29
ISBN (print)
9789461690760

Funding

Sponsorship
Netherlands Heart Foundation; Covidien Nederland BV; Siemens Nederland NV; Astellas BV; Nycomed BV; J.E. Jurriaanse Stichting; Boehringer Ingelheim BV; B. Braun Medical BV; Astrazeneca BV; Mortara BV; Drager Medical Netherlands BV; St Jude Medical Netherlands BV; Servier Netherlands farma BV