Superiority of end-diastolic volume and ejection fraction measurements over wedge pressures in evaluating cardiac function during aortic reconstruction.
Marked changes occur in cardiac function during aortic reconstruction. Numerous factors (primarily compliance changes) limit the currently used pressure-based pulmonary artery catheters' ability to reflect these changes accurately. A new pulmonary artery catheter was used in 26 patients undergoing aortic reconstruction (7 patients with abdominal aortic aneurysms and 19 with occlusive disease) that directly measures right ventricular (RV) volumes and ejection fractions. The extent of coronary artery disease (CAD) was evaluated before surgery, and the patients were divided into three classes. The greatest changes in cardiac function were noted immediately after aortic cross-clamping. Cardiac output significantly decreased in patients with mild or moderate CAD (p less than 0.01 and p less than 0.001) but not in patients with no CAD (p less than 0.5). This correlated well with RV end-diastolic volume (RV-EDV) and stroke volume (RV-SV) measurements in the groups with mild (p less than 0.05) and moderate CAD (p less than 0.01) but not in the group with no CAD (p greater than 0.5). Wedge pressure showed poor correlation, with no significant change noted in any group (p greater than 0.5). Measurements taken later in the procedure documented a significant trend toward baseline in mild and moderate groups. At the opening of the second limb of the graft, the compensated values (CO, RV-EDV, and RV-SV) did not change significantly in the groups with mild and no CAD (p greater than 0.2) but approached significance in the group with moderate CAD (p less than 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)
Dennis
J W
JW
Department of Surgery, University of Florida Health Science Center, Jacksonville 32209.
Menawat
S S
SS
Sobowale
O O
OO
Adams
C
C
Crump
J M
JM
D001012:Aorta, Abdominal / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery*; D002302:Cardiac Output / Q000502:physiology; D003327:Coronary Disease / Q000150:complications; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*; D013815:Thermodilution; D016278:Ventricular Function, Right / Q000502:physiology