Anesthetic Management of New Left Ventricular Reduction Surgery (OLCVR : Overlapping cardiac volume reduction operation) for Dilated Cardiomyopathy

Abstract

We experienced anesthetic management for ten cases of overlapping cardiac volume reduction operation (OLCVR) for treating end-stage non-ischemic dilated cardiomyopathy. This is a new procedure for left ventricular volume reduction without any resection of cardiac muscle, and it has beneficial effects. The anesthesia was maintained with intravenous anesthetics and low-dose sevoflurane. When weaning from cardio-pulmonary bypass, transesophageal echocardiography provided information on determining cardiac dimensions and evaluating left ventricular wall motion. In the early stage of weaning, cardioplesia and bundle branch block induced asynergic wall motion. Therefore it is important to wait until coordinated wall motion appears. It was useful to use vasodilators, catecholamines, and phosphodiesterase III inhibitors to control preload and afterload. But dopamine and dobutamine should be avoided, because those might cause cardiac ischemia due to increase a heart rate and oxygen consumption without inotropic effect.