VENTRICULAR FUNCTION DURING CARDIAC SURGERY

Summary

Principal Investigator: HENRY SPOTNITZ
Abstract: DESCRIPTION (Provided by Applicant): These studies will examine the effect of surgical correction of acquired and congenital heart disease on the systolic and diastolic properties of the left and right ventricles in human adults, children, and infants. State of the art measuring devices and algorithms will be employed for intraoperative measurements and long-term followup. Improved pump function during corrective surgery will be correlated with changes in myocardial properties, since impaired contractility and compliance can be hidden by improved hemodynamics. For specific operations in which the pathophysiology of surgical correction is not well understood, mechanisms that promote a successful long term result will be defined. Outpatient studies will examine chronic changes in ventricular size and function, which will be related to intraoperative events. Laboratory studies will develop advanced methods for intraoperative study and reduce the cost of such studies, making the technology widely available. Intraoperative measurements will include pressure by micromanometer, flow by electromagnetic or ultrasonic flowmeter, and dimensions by sonomicrometry, two-dimensional echocardiography, and ventricular conductance. End-diastolic volume will be correlated with end-diastolic pressure to measure compliance, and with pressure-volume stroke work to measure contractile function (preload recruitable stroke work). Contractility will also be measured from pressure-volume loops (end-systolic pressure-volume relation). End-diastolic pressure-ventricular performance relations will also be measured, since these directly influences patient symptoms. These goals will be accomplished by a dedicated faculty with the right combination of clinical experience and laboratory background to conduct such studies effectively and safely. Results will improve care of patients undergoing cardiac surgery, will clarify deficiencies of current management, will expand understanding of the pathophysiology of heart surgery, and will make low cost methods for the study of systolic and diastolic properties generally available to cardiac surgeons and laboratory scientists.
Funding Period: 1992-05-01 - 2006-06-30
more information: NIH RePORT

Top Publications

  1. pmc Feasibility of in vivo pressure measurement using a pressure-tip catheter via transventricular puncture
    Robert G Gray
    Department of Pediatrics, Division of Pediatric Cardiology, The University of Utah, Salt Lake City, Utah, USA
    ASAIO J 56:194-9. 2010
  2. ncbi Ventricular function in surgery for congenital heart disease
    Henry M Spotnitz
    Department of Surgery, Columbia University Medical Center, Vanderbilt Clinic 1010, 622 W 168th Street, New York, NY 10032, USA
    World J Surg 34:669-74. 2010
  3. pmc Direction of preoperative ventricular shunting affects ventricular mechanics after Tetralogy of Fallot repair
    Marc E Richmond
    Department of Surgery Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
    Circulation 118:2338-44. 2008
  4. ncbi Left ventricular pacing site and timing optimization during biventricular pacing using a multielectrode patch in pigs
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
    J Thorac Cardiovasc Surg 134:574-8. 2007
  5. ncbi Left ventricular pacing site-timing optimization during biventricular pacing using a multi-electrode patch
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
    Ann Thorac Surg 82:2292-4. 2006
  6. ncbi Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation
    Cara A Garofalo
    Department of Pediatrics, Columbia College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    Circulation 114:I56-61. 2006
  7. ncbi Effects of sequential biventricular pacing during acute right ventricular pressure overload
    T Alexander Quinn
    Columbia Univ College of Physicians and Surgeons, 622 W 168th St, PH 14 103, New York, NY 10032, USA
    Am J Physiol Heart Circ Physiol 291:H2380-7. 2006
  8. ncbi Load dependence of cardiac output in biventricular pacing: left ventricular volume overload in pigs
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
    J Thorac Cardiovasc Surg 131:666-70. 2006
  9. ncbi Ethanol induction of complete heart block in swine
    Jon Emile S Kenny
    Department of Surgery, Columbia University, College of Physicians and Surgeons, 622 W 168th St, New York, New York 10032, USA
    J Surg Res 132:142-6. 2006
  10. ncbi Optimized biventricular pacing in atrioventricular block after cardiac surgery
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
    Ann Thorac Surg 80:870-5. 2005

Scientific Experts

  • HENRY SPOTNITZ
  • George Berberian
  • T Alexander Quinn
  • Santos E Cabreriza
  • Alan D Weinberg
  • David G Rabkin
  • Lauren J Curtis
  • Robert G Gray
  • Marc E Richmond
  • Ralph S Mosca
  • Jan M Quaegebeur
  • Cara A Garofalo
  • Jon Emile S Kenny
  • Jason E Prasso
  • Jason P Van Batavia
  • Joshua P Kanter
  • Jeffrey W Holmes
  • Lauren J Maskin
  • Beth F Printz
  • Daphne T Hsu

Detail Information

Publications14

  1. pmc Feasibility of in vivo pressure measurement using a pressure-tip catheter via transventricular puncture
    Robert G Gray
    Department of Pediatrics, Division of Pediatric Cardiology, The University of Utah, Salt Lake City, Utah, USA
    ASAIO J 56:194-9. 2010
    ..Transventricular placement of a 2-Fr PTC is feasible and should allow evaluation of ventricular mechanics during surgical repair of congenital heart disease...
  2. ncbi Ventricular function in surgery for congenital heart disease
    Henry M Spotnitz
    Department of Surgery, Columbia University Medical Center, Vanderbilt Clinic 1010, 622 W 168th Street, New York, NY 10032, USA
    World J Surg 34:669-74. 2010
    ..CONCLUSIONS These methods and advanced animal models replicating conditions of surgery for cyanotic congenital heart disease set the stage for clinical advances in this important area...
  3. pmc Direction of preoperative ventricular shunting affects ventricular mechanics after Tetralogy of Fallot repair
    Marc E Richmond
    Department of Surgery Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
    Circulation 118:2338-44. 2008
    ....
  4. ncbi Left ventricular pacing site and timing optimization during biventricular pacing using a multielectrode patch in pigs
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
    J Thorac Cardiovasc Surg 134:574-8. 2007
    ..Although left ventricular lead location and right ventricular-left ventricular delay are believed to be critical in biventricular pacing, there is no established technique for optimizing pacing site and timing...
  5. ncbi Left ventricular pacing site-timing optimization during biventricular pacing using a multi-electrode patch
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
    Ann Thorac Surg 82:2292-4. 2006
    ..The difference between the best and worst site-timing combinations altered cardiac index by nearly 70%. This experience demonstrates potential importance of the epicardial approach to site-timing optimization for biventricular pacing...
  6. ncbi Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation
    Cara A Garofalo
    Department of Pediatrics, Columbia College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
    Circulation 114:I56-61. 2006
    ..We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions...
  7. ncbi Effects of sequential biventricular pacing during acute right ventricular pressure overload
    T Alexander Quinn
    Columbia Univ College of Physicians and Surgeons, 622 W 168th St, PH 14 103, New York, NY 10032, USA
    Am J Physiol Heart Circ Physiol 291:H2380-7. 2006
    ....
  8. ncbi Load dependence of cardiac output in biventricular pacing: left ventricular volume overload in pigs
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
    J Thorac Cardiovasc Surg 131:666-70. 2006
    ..We hypothesized that a model of left ventricular volume overload would also have specific timing requirements during biventricular pacing for optimization of cardiac output...
  9. ncbi Ethanol induction of complete heart block in swine
    Jon Emile S Kenny
    Department of Surgery, Columbia University, College of Physicians and Surgeons, 622 W 168th St, New York, New York 10032, USA
    J Surg Res 132:142-6. 2006
    ..The literature review was undertaken to both compare our rate of success with other methods and provide insight into our technique and refine its implementation...
  10. ncbi Optimized biventricular pacing in atrioventricular block after cardiac surgery
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
    Ann Thorac Surg 80:870-5. 2005
    ..We hypothesized that by optimizing both atrioventricular delay and ventricular pacing site a 10% improvement in cardiac output would be observed compared with a standard pacing protocol...
  11. ncbi Optimized perioperative biventricular pacing in setting of right heart failure
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, 622 West 168th Street, PH 14 103, New York, NY 10032, USA
    Europace 7:385-7. 2005
    ..Effects of biventricular pacing were tested with temporary wires at the conclusion of cardiopulmonary bypass...
  12. ncbi Na+/H+ exchange inhibition and antioxidants lack additive protective effects after reperfusion injury in the working heterotopic rat heart isograft
    David G Rabkin
    Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
    J Heart Lung Transplant 24:386-91. 2005
    ..The utility of combining strategies of myocardial protection was studied in intact rat hearts subjected to 1 hour of ischemia and 40 minutes blood reperfusion...
  13. ncbi Validation study of PulseCO system for continuous cardiac output measurement
    George Berberian
    Department of Surgery, Columbia University, College of Physicians and Surgeons, New York 10032, USA
    ASAIO J 51:37-40. 2005
    ..13 vs. 1.79 L/min, p = 0.003). PulseCO appears to be useful for assessing acute changes in CO if its limitations are recognized...
  14. ncbi Validation of mean arterial pressure as an indicator of acute changes in cardiac output
    Jason E Prasso
    Columbia College, New York, USA
    ASAIO J 51:22-5. 2005
    ..60[%CO] - 0.41, p = 0.0001). This study validates the use of MAP as an indicator of acute changes in CO. Fluctuations in MAP correlate well with acute changes in CO in the absence of changes in vascular tone...