Modern monitoring methods informativeness in assessing the risk of hemodynamic disorders in on pump cardiac surgery (pilot study)

The objective was to study the prognostic significance of intraoperative parameters of pulmonary artery catheterization (PAC), transesophageal echocardiography (TEE) and transpulmonary thermodilution (TPTD) in relation to the hemodynamic disorders in coronary artery bypass grafting (CABG).
Material and Methods. A prospective observational study involved 67 patients aged 53 [46–64] years who underwent on-pump CABG. Hemodynamic parameters were recorded after the induction of anesthesia (stage I) and at the end of the surgery (stage II). Hemodynamic disorders were considered to be the inotropic index in post-bypass period >5, the duration of inotropic support >12 hours, the intensive care unit (ICU) stay >24 hours, the use of intraaortic balloon pumping (IABP), the ICU mortality, the presence of one or more complications (composite outcome). Logistic regression and ROC analysis were used.
Results. At stage I, the left ventricular stroke work index (LVSWI) cut-off <31.7 gs•m/m2 was associated with ICU stay >24 hours (OR 0.9291, 95 % CI 0.8670–0.9958, AUC 0.716), and LVSWI <32.5 gs•m/m² – with a composite the outcome (OR 0.9550, 95 % CI 0.9133–0.9985, AUC 0.704). The left ventricular area contraction fraction <34.2 % predicted the use of IABP (OR 0.9089, 95 % CI 0.8397–0.9839, AUC 0.889). At the II stage, the LVSWI cut-off <28.8 gs•m/m² was associated with ICU stay >24 hours (OR 0.8805, 95 % CI 0.8226–0.9884, AUC 0.716), cut-off <25.6 gs•m/m² – with the use of IABP (OR 0.8274, 95 % CI 0.7101–0.9641, AUC 0.804), and cut-off <23.0 gs•m/m² – with mortality (OR 0.7486, 95 % CI 0.5951–0.9415, AUC 0.892). The left ventricular ejection fraction <26.1 % was also associated with mortality (OR 0.8901, 95 % CI 0.8164–0.9705, ACC 0.948). The global heart ejection fraction <18 % was associated with a composite outcome (OR 0.9018, 95 % CI 0.8297–0.9802, AUC 0.716). The other predictors cut-off values were practically normal. The remaining indicators provided models of average quality or had no predictive significance.
Conclusion. To assess the risk of possible hemodynamic disorders in on-pump CABG, PAC and TEE are the most informative. In prebypass and in postbypass periods, LVSWI, reduced by 1.5–2.2 times, is associated with the risk of various hemodynamic complications and prolonged ICU stay. Decreased TEE parameters of left ventricular systolic function is associated with myocardial dysfunction and with the risk of mortality. The prognostic significance of the TPTD needs further investigations.

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