Impact of cardiac surgery on the autonomic cardiovascular function
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Impact of cardiac surgery on the autonomic cardiovascular function Sebastian Zaunseder1* , Maik Riedl2 , Jürgen Kurths3 , Hagen Malberg1 , Robert Bauernschmitt4 and Niels Wessel2 *Correspondence: sebastian. [email protected] 1 Institute of Biomedical Engineering, TU Dresden, Helmholtzstraße 18, Dresden 01069, Germany Full list of author information is available at the end of the article
Abstract Background: The study compares the impact of cardiac surgical interventions on the autonomic function by assessing the pre-operative status and early post-operative recovery of subjects undergoing isolated mitral valve replacement (MVR), isolated aortic valve replacement (AVR), and transcatheter aortic valve implantation (TAVI). We analyze heart rate variability (HRV), baroreflex sensitivity (BRS), and cardiovascular coupling in a longitudinal, i.e., the temporal evolution of autonomic function within each group before, 1 day after, and 7 days after surgery, and a transversal, i.e., between groups of patients at identical time instants, setting. Results: A total of 243 records from 124 patients (38 MVR, 57 AVR, 29 TAVI) was analyzed. There were no major differences in HRV, BRS, and coupling between the groups in the pre-operative values. Longitudinal analysis proves a depressed autonomic function for MVR and AVR patients after surgery (in MVR patients, p < 0.001 for most parameters related to HRV and BRS), but not for TAVI patients. TAVI patients showed no differences before and after surgery. Transversal analysis reveals the strongest impairments throughout HRV and BRS parameters for MVR patients. In the case of AVR, the autonomic regulation was also depressed, though not to the extent as seen in MVR patients. Cardiovascular coupling by means of symbolic coupling traces (SCT) was shown to be clearly reduced the day after surgery in MVR and AVR patients. In TAVI patients, there was no reduction but already the day after surgery developed additional couplings. Conclusions: Our results prove a characteristic behavior of the autonomic function in relation to the gravity of the surgical procedure. As variables related to the process of the surgical interventions were kept similar between patient groups, direct surgical trauma is assumed to be responsible for the heavy decrease of autonomic function in the case of MVR. TAVI, in contrast, proves to be very suited in terms of maintaining the autonomic function in comparison to AVR. Further studies incorporating larger populations should confirm our findings and relate the autonomic state to malignant events after surgical interventions to build the fundament of a strengthened inclusion of cardiovascular variability and coupling analysis in the pre-, peri-, and post-operative care. Keywords: Autonomic function; Heart rate variability; Baroreflex sensitivity; Cardiovascular coupling; Aortic valve replacement; Mitral valve replacement; Transcatheter aortic valve implantation
© 2014 Zaunseder et al.; licensee Springer. This is an Open Access article d
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