title: Cardiac output measurement during infrarenal aortic surgery: echo-esophageal Doppler versus thermodilution catheter.
abstract: OBJECTIVE
  Aortic surgery is associated with various hemodynamic and cardiac output modifications. These disorders may be partly caused by blood flow redistribution between supra-aortic and descending aorta regions during clamping and unclamping. A new echo-esophageal Doppler (Hemosonic 100; Arrow, Reading, PA) calculates cardiac output from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. This calculation may be affected by blood redistribution during aortic clamping. The aim of this study was to compare cardiac output measured by echo-esophageal Doppler and by bolus thermodilution catheter during infrarenal aortic surgery.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University hospital, single institution.
  
  
  METHODS
  Twenty-two adult patients.
  
  
  METHODS
  Infrarenal aortic surgery.
  
  
  RESULTS
  Cardiac outputs monitored by both devices were highly correlated during the whole surgical procedure (r2 ranging from 0.54 to 0.76). Bland and Altman analysis showed absence of significant bias before and after clamping (ranging from 0.1 +/- 0.73 L/min to 0.18 +/- 1 L/min, p > 0.05) and a significant bias of 0.5 +/- 1.05 L/min (p < 0.05) during aortic clamping. Limits of agreement did not differ significantly during the whole surgical procedure (ranging from -1.36/2.19 to -2.23/2.49). During clamping and unclamping, changes in cardiac output obtained by both methods were positively correlated (r2 = 0.7).
  
  
  CONCLUSIONS
  Bias between both methods was clinically acceptable, and limits of agreement were not significantly modified by aortic clamping. However, larger studies including homogenous aortic pathologies are necessary to validate this method during infrarenal aortic surgery.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital Beaujon, Clichy, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Lafanechère
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
authors.forename: Rémi
authors.initials: R
authors.lastname: Bocquet
authors.forename: Anne
authors.initials: A
authors.lastname: Wernet
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D002302:Cardiac Output; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013815:Thermodilution / Q000379:methods*